Basic Information
| Provider Information | |||||||||
| NPI: | 1174195804 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRAZIS | ||||||||
| FirstName: | SAVANNAH | ||||||||
| MiddleName: | ASHLEY | ||||||||
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| Credential: | FNP, RN-BSN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2008 PROVIDENCE WALK | ||||||||
| Address2: | |||||||||
| City: | WOODSTOCK | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301895277 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6789234948 | ||||||||
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| Practice Location | |||||||||
| Address1: | 470 NORTHSIDE CHEROKEE BLVD STE 375 | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301158029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704220444 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2021 | ||||||||
| LastUpdateDate: | 07/13/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | F04210493 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.