Provider Demographics
NPI:1427112085
Name:ALIOTTA, BRANDY T (NP)
Entity type:Individual
Prefix:MRS
First Name:BRANDY
Middle Name:T
Last Name:ALIOTTA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:BRANDY
Other - Middle Name:
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:836 E. 65TH STREET
Mailing Address - Street 2:SUITE 22
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405
Mailing Address - Country:US
Mailing Address - Phone:912-819-7878
Mailing Address - Fax:912-819-3320
Practice Address - Street 1:5354 REYNOLDS STREET
Practice Address - Street 2:SUITE 518
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405
Practice Address - Country:US
Practice Address - Phone:912-819-9650
Practice Address - Fax:912-819-9651
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN142957363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA403820OtherWELLCARE
GA820053930BMedicaid
GA820053930AMedicaid
GA01067200OtherAMERIGROUP
GAP00443152OtherRR MEDICARE
GA820053930AMedicaid
GA820053930BMedicaid
GA202I507469Medicare PIN