Provider Demographics
NPI:1861105587
Name:FRECKLETON, BRIANNA (RN, MSN, AGACNP-BC)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:
Last Name:FRECKLETON
Suffix:
Gender:F
Credentials:RN, MSN, AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 CHARLESTON DR
Mailing Address - Street 2:
Mailing Address - City:SENOIA
Mailing Address - State:GA
Mailing Address - Zip Code:30276-2370
Mailing Address - Country:US
Mailing Address - Phone:907-744-3206
Mailing Address - Fax:
Practice Address - Street 1:2513 REDWINE RD SUITE B
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30215
Practice Address - Country:US
Practice Address - Phone:907-744-3206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-27
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN285345363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner