Individual
MR. TIAGO POLESELLI BRUNIERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1199 PRINCE AVE FL 2, ATHENS, GA 30606
(706) 475-1700
(706) 475-1790
Mailing address
2727 PACES FERRY ROAD SE, SUITE 1-1100 (ATTN: DENISE), ATLANTA, GA 30339
(470) 271-3421
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
007644
GA
Other
Enumeration date
09/17/2013
Last updated
07/12/2018
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