Provider Demographics
NPI:1063694859
Name:MURRELL, BRIAN PATRICK (PA)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:PATRICK
Last Name:MURRELL
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:758 OLD NORCROSS RD
Mailing Address - Street 2:STE 175
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-3388
Mailing Address - Country:US
Mailing Address - Phone:770-267-6565
Mailing Address - Fax:
Practice Address - Street 1:705 BREEDLOVE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-2090
Practice Address - Country:US
Practice Address - Phone:770-267-6565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-04
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005100363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPSL 120146006OtherMUTUAL INSURANCE COMPANY