Individual
MRS. SHANA BROOKE BRADLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1300 RIDENOUR BLVD NW STE 300, KENNESAW, GA 30152-4402
(770) 702-1806
Mailing address
885 MABLE LAKE RD, CUMMING, GA 30041-8575
(770) 597-3247
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN239256
GA
367500000X
Certified Registered Nurse Anesthetist
Primary
RN239256
GA
Other
Enumeration date
12/09/2020
Last updated
07/25/2024
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