Healthcare Provider Details

I. General information

NPI: 1487678496
Provider Name (Legal Business Name): PATRICIA ANN BROOKS MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 FREEDOM WAY
AUGUSTA GA
30904-6258
US

IV. Provider business mailing address

202 AMBASSADOR DR
NORTH AUGUSTA SC
29841-9213
US

V. Phone/Fax

Practice location:
  • Phone: 706-733-0188
  • Fax:
Mailing address:
  • Phone: 803-593-8174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN074174
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: