=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083785380
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUSAN C. BRIM DR.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/10/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 N JEFFERSON ST
-----------------------------------------------------
City | ALBANY
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31701-2359
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 229-435-8351
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 598 1000 BRIM RD
-----------------------------------------------------
City | SASSER
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 39885-0598
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 229-698-5582
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 14644
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------