1740524024 NPI number — MISS TONIA LOUELL BRIGHTLY CNA, AAB

Table of content: MISS TONIA LOUELL BRIGHTLY CNA, AAB (NPI 1740524024)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740524024 NPI number — MISS TONIA LOUELL BRIGHTLY CNA, AAB

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRIGHTLY
Provider First Name:
TONIA
Provider Middle Name:
LOUELL
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
CNA, AAB
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740524024
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/26/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3230 MERCER UNIVERSITY DR
Provider Second Line Business Mailing Address:
APARTMENT 104
Provider Business Mailing Address City Name:
CHAMBLEE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30341-7000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-404-8528
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3230 MERCER UNIVERSITY DR
Provider Second Line Business Practice Location Address:
APARTMENT 104
Provider Business Practice Location Address City Name:
CHAMBLEE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30341-7000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-404-8528
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/26/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 374U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 376K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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