Individual
MR. GLENN CLAYTON BRANTLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
2435 FOREST DR, COLUMBIA, SC 29204-2026
(803) 865-4934
Mailing address
2750 LAUREL ST STE 103, COLUMBIA, SC 29204-2023
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
29080
SC
Other
Enumeration date
10/16/2024
Last updated
10/16/2024
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