Provider Demographics
NPI:1457812984
Name:TANKS, BRANDI (LMT, RMT,MMP, MBA)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:
Last Name:TANKS
Suffix:
Gender:F
Credentials:LMT, RMT,MMP, MBA
Other - Prefix:
Other - First Name:BRANDI
Other - Middle Name:NICOLE
Other - Last Name:TANKS-RENCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MMP
Mailing Address - Street 1:8325 OFFICE PARK DR STE C-2
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-6936
Mailing Address - Country:US
Mailing Address - Phone:470-787-2546
Mailing Address - Fax:470-878-2536
Practice Address - Street 1:8325 OFFICE PARK DR STE C-2
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-6936
Practice Address - Country:US
Practice Address - Phone:470-787-2546
Practice Address - Fax:470-878-2536
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101YP1600X, 173C00000X
171400000X, 246RM2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical Laboratory
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No171400000XOther Service ProvidersHealth & Wellness Coach
No173C00000XOther Service ProvidersReflexologist