Individual
MRS. BRANDI NICHELLE MONROE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
725 JESSE JEWELL PKWY SE, GAINESVILLE, GA 30501-3834
(678) 207-4000
(770) 531-2435
Mailing address
PO BOX 658, GAINESVILLE, GA 30503-0658
(770) 718-1122
(770) 533-4786
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
Primary
006265
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003116076D
—
GA
05
—
003116076E
—
GA
05
—
003116076F
—
GA
01
—
01635237
AMERIGROUP
GA
01
—
680875
WELLCARE
GA
Enumeration date
09/15/2011
Last updated
05/13/2021
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