Individual
MR. SHANNON BRANTLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T, A.T.C.
Contact information
Practice address
101 HARRIS INDUSTRIAL BLVD, VIDALIA, GA 30474-8845
(912) 277-2044
Mailing address
PO BOX 404, ADRIAN, GA 31002-0404
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
PT 007647
GA
2255A2300X
Athletic Trainer
Primary
AT 001133
GA
Other
Enumeration date
05/11/2007
Last updated
09/11/2025
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