Provider Demographics
NPI:1801533146
Name:BRASWELL, LEAH MARIE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:MARIE
Last Name:BRASWELL
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3488 HEATHERWOOD CT
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-1954
Mailing Address - Country:US
Mailing Address - Phone:469-412-6605
Mailing Address - Fax:
Practice Address - Street 1:3488 HEATHERWOOD CT
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-1954
Practice Address - Country:US
Practice Address - Phone:469-412-6605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-18
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN266519363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner