Individual
MR. BRANDON BLAKELY BISSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
1514 VERNON RD, LAGRANGE, GA 30240-4131
(706) 882-1411
Mailing address
10545 SUMMER CREEK DR, ALPHARETTA, GA 30022-5084
(706) 631-5247
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN220792
GA
Other
Enumeration date
05/07/2019
Last updated
05/07/2019
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