Individual
BRANDI MICHELLE WYNNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
420 CHARTER BLVD STE 402, MACON, GA 31210-0722
(478) 757-6400
Mailing address
PO BOX 1213, BRUNSWICK, GA 31521-1213
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
60635
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
626638414R
—
GA
Enumeration date
05/11/2007
Last updated
01/14/2025
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