Healthcare Provider Details

I. General information

NPI: 1366145708
Provider Name (Legal Business Name): SARAH MARIE BROCK FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2023
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 DEARING EXT BLDG 3
ATHENS GA
30606-3579
US

IV. Provider business mailing address

PO BOX 658
GAINESVILLE GA
30503-0658
US

V. Phone/Fax

Practice location:
  • Phone: 706-389-1095
  • Fax:
Mailing address:
  • Phone: 770-718-1122
  • Fax: 770-533-4786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP282885
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberAPRN-NP282885
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: