Provider Demographics
NPI:1912929225
Name:BRANNON, LINDA JEANNE (CNP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:JEANNE
Last Name:BRANNON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:J
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:993 JOHNSON FERRY RD
Mailing Address - Street 2:BLDG C, STE 120
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1620
Mailing Address - Country:US
Mailing Address - Phone:404-790-7860
Mailing Address - Fax:404-851-8673
Practice Address - Street 1:993 JOHNSON FERRY RD
Practice Address - Street 2:BLDG C, STE 120
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1620
Practice Address - Country:US
Practice Address - Phone:404-790-7860
Practice Address - Fax:404-851-8673
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN205972363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003134452DMedicaid
OH2563533Medicaid
GA202I502825Medicare PIN
OH2563533Medicaid