Provider Demographics
NPI:1609947274
Name:BRIGHAM, ALISON SEWELL (CRNA)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:SEWELL
Last Name:BRIGHAM
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 204097
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30917-4097
Mailing Address - Country:US
Mailing Address - Phone:762-224-3005
Mailing Address - Fax:
Practice Address - Street 1:1120 15TH ST
Practice Address - Street 2:ROOM 2144
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-0004
Practice Address - Country:US
Practice Address - Phone:706-721-3873
Practice Address - Fax:706-721-7763
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN135152367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA760294324AMedicaid
GAP00094184OtherRRMEDICARE
GA760294324DMedicaid
GA339033OtherWELLCARE CMO
SCGAN513Medicaid
GA550789920OtherTRICARE
GA760294324AMedicaid