Korema Roshawn Brantley, FNP
Individual provider Active NPI Nurse Practitioner · Guyton, GA
NPI 1245087667 · NPPES record last updated May 2, 2024
Key facts
- NPI
- 1245087667
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- RN263649 (GA)
- Practice address
- 103 Old School Cir
Guyton, GA 31312-5639 - Phone
- (912) 572-8222
- NPI assigned
- May 2, 2024
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250217002017 | GA | Practitioner - Nurse Practitioner | 0941720239 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN263649 | GA | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Infinite Medical PC | Nurse Practitioner | Current |
Accepting new patients |
Locations
22 Maple Ridge Dr
Cartersville, GA 30121
Phone (770) 606-8800
250 Skillman St
Ste 202
Brooklyn, NY 11205
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | RN263649 | GA | Yes |
Addresses
Primary practice location
103 Old School Cir
Guyton, GA 31312-5639
Mailing address
103 Old School Cir
Guyton, GA 31312-5639
Phone (912) 572-8222
Other providers in Guyton, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 2, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.