Provider Demographics
NPI:1881081313
Name:BRIGNOLLE, JAMES
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:BRIGNOLLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1044 FIELD VIEW DR
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-9021
Mailing Address - Country:US
Mailing Address - Phone:862-224-0967
Mailing Address - Fax:404-891-1827
Practice Address - Street 1:821 PAVILION CT
Practice Address - Street 2:SUITE B
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-5222
Practice Address - Country:US
Practice Address - Phone:404-399-5836
Practice Address - Fax:404-891-1827
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-22
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAA002498343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)