Healthcare Provider Details

I. General information

NPI: 1194544551
Provider Name (Legal Business Name): LUCY BROOKS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2024
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6015 ROSWELL RD
SANDY SPRINGS GA
30328-4005
US

IV. Provider business mailing address

6075 ROSWELL RD
SANDY SPRINGS GA
30328-4008
US

V. Phone/Fax

Practice location:
  • Phone: 404-689-4501
  • Fax:
Mailing address:
  • Phone: 912-223-3325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN312477
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN312477
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: