Healthcare Provider Details

I. General information

NPI: 1245588359
Provider Name (Legal Business Name): BREMEKA GILBERT LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2012
Last Update Date: 08/06/2020
Certification Date: 08/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2233 W POINT RD
LAGRANGE GA
30240-4061
US

IV. Provider business mailing address

444 LEE ROAD 2206
SALEM AL
36874-1755
US

V. Phone/Fax

Practice location:
  • Phone: 706-837-0045
  • Fax:
Mailing address:
  • Phone: 706-773-6211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: