Provider Demographics
NPI:1669110920
Name:JAMES, BRIANNA JENNIFER (COSMETOLOGIST)
Entity type:Individual
Prefix:MS
First Name:BRIANNA
Middle Name:JENNIFER
Last Name:JAMES
Suffix:
Gender:F
Credentials:COSMETOLOGIST
Other - Prefix:MS
Other - First Name:BRIANNA
Other - Middle Name:JENNIFER
Other - Last Name:JAMES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COSMETOLOGIST
Mailing Address - Street 1:3503 MCCALLISTER LN
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-7500
Mailing Address - Country:US
Mailing Address - Phone:908-917-6058
Mailing Address - Fax:
Practice Address - Street 1:1359 MILSTEAD RD NE STE 201
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3865
Practice Address - Country:US
Practice Address - Phone:770-679-9264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACO132578224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist