Individual
RANDALL JAY BRANTLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
701 GROVE RD, GMH 2ND FLOOR ANESTHESIA DEPT, GREENVILLE, SC 29605-5611
(864) 455-7111
Mailing address
1 INDEPENDENCE PT STE 212, GREENVILLE, SC 29615-4536
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
0168
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
430027455
MEDICARE RAILROAD
SC
05
—
AN0181
—
SC
Enumeration date
09/29/2006
Last updated
11/03/2017
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