Healthcare Provider Details

I. General information

NPI: 1114847944
Provider Name (Legal Business Name): MS. DEMETRIC CHAVONNE BROOKS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 19TH ST N STE 201
BIRMINGHAM AL
35203-3219
US

IV. Provider business mailing address

107 EVANS ST
MARION AL
36756-6709
US

V. Phone/Fax

Practice location:
  • Phone: 334-930-6972
  • Fax:
Mailing address:
  • Phone: 334-930-6972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: