Provider Demographics
NPI:1538545371
Name:BRANTLEY, BARBARA LEE (MED, CCC-SLP)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:LEE
Last Name:BRANTLEY
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:ANN
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1801 W SCREVEN ST
Mailing Address - Street 2:
Mailing Address - City:QUITMAN
Mailing Address - State:GA
Mailing Address - Zip Code:31643-3620
Mailing Address - Country:US
Mailing Address - Phone:229-263-7868
Mailing Address - Fax:229-584-7142
Practice Address - Street 1:1801 W SCREVEN ST
Practice Address - Street 2:
Practice Address - City:QUITMAN
Practice Address - State:GA
Practice Address - Zip Code:31643-3620
Practice Address - Country:US
Practice Address - Phone:229-263-7868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP009347235Z00000X
GAPCET002235235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003178241AMedicaid