Individual
MRS. BRANDY NICHOLS OWENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1514 VERNON RD, LAGRANGE, GA 30240
(706) 880-7222
Mailing address
1514 VERNON RD, LAGRANGE, GA 30240-4131
(706) 880-7222
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
005435
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
785556519B
—
GA
05
—
785556519C
—
GA
Enumeration date
10/07/2008
Last updated
06/28/2021
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