Healthcare Provider Details

I. General information

NPI: 1356225544
Provider Name (Legal Business Name): BRIAR CREEK FAMILY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2025
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

639 VESTAL RD
SARDIS GA
30456-2155
US

IV. Provider business mailing address

1 CHATHAM STREET EXT
SARDIS GA
30456-2000
US

V. Phone/Fax

Practice location:
  • Phone: 706-834-3731
  • Fax:
Mailing address:
  • Phone: 706-834-3731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: STACIE D BUCKLEY
Title or Position: OWNER
Credential: FNP-C
Phone: 706-834-3731