Healthcare Provider Details

I. General information

NPI: 1114285038
Provider Name (Legal Business Name): TAMMIE V BRICKHOUSE CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2012
Last Update Date: 03/28/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 TULLIE RD NE
ATLANTA GA
30329-2309
US

IV. Provider business mailing address

980 LAWRENCEVILLE HWY
LAWRENCEVILLE GA
30046-4706
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-5437
  • Fax:
Mailing address:
  • Phone: 770-962-8025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN149012
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: