Provider Demographics
NPI:1356887053
Name:LEE, BRANDIE SHANDELLE (NP)
Entity type:Individual
Prefix:MRS
First Name:BRANDIE
Middle Name:SHANDELLE
Last Name:LEE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:BRANDIE
Other - Middle Name:SHANDELLE
Other - Last Name:CAROLINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1705 HIGHWAY 138 SE UNIT 83451
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-0162
Mailing Address - Country:US
Mailing Address - Phone:678-374-2575
Mailing Address - Fax:
Practice Address - Street 1:5530 N HENRY BLVD
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-3220
Practice Address - Country:US
Practice Address - Phone:678-374-2575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-18
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN221736363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health