Individual
JACQUELYN HUDAK BRANTLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MMSC
Contact information
Practice address
235 PEACHTREE ST NE, NORTH TOWER, SUITE 2100, ATLANTA, GA 30303-1401
(770) 994-9326
Mailing address
3112 ALSTON DR, DECATUR, GA 30032-3301
(770) 833-8386
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
006743
GA
Other
Enumeration date
03/11/2013
Last updated
03/11/2013
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