Individual
MRS. BRANTLEY LYNN STANDARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
801 W GORDON ST, THOMASTON, GA 30286-3426
(706) 647-8111
Mailing address
801 W GORDON ST, THOMASTON, GA 30286-3426
(706) 647-8111
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
RN219738
GA
363L00000X
Nurse Practitioner
Primary
RN219738
GA
Other
Enumeration date
01/16/2019
Last updated
02/15/2019
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