Healthcare Provider Details

I. General information

NPI: 1770830408
Provider Name (Legal Business Name): KATYA MONET BRICKMAN MSN, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2012
Last Update Date: 09/08/2022
Certification Date: 09/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 S 8TH ST
GRIFFIN GA
30224-4211
US

IV. Provider business mailing address

503 S 8TH ST
GRIFFIN GA
30224-4211
US

V. Phone/Fax

Practice location:
  • Phone: 770-227-5505
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0205348
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberRN256354
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: