Organization
PAI PARTICIPANT 11 PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRITTAIN BRANTLEY (ACTING PRESIDENT)
(302) 300-5138
Entity
Organization
Contact information
Practice address
415 AIRPORT RD, GRIFFIN, GA 30224-4834
(770) 227-8636
Mailing address
PO BOX 639676, CINCINNATI, OH 45263-9676
(859) 291-4800
(859) 655-8588
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
—
—
Other
Enumeration date
05/20/2019
Last updated
08/13/2026
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