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General NPI Number Information
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NPI Number | 1548937618
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Entity Type | Individual
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Provider Name | BRIANA WATKINS CLARKE
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Gender | Female
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Dates
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Enumeration Date | 08/26/2021
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Last Update Date | 02/28/2022
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Provider Practice Location Address
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Address Line | 2429 MARTIN LUTHER KING JR DR SW
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City | ATLANTA
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State | GA
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Zip | 30311-1713
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Country | US
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Telephone | 586-710-0022
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Fax |
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Provider Business Mailing Address
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Address Line | 2415 OAKLEAF CIR
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City | LITHONIA
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State | GA
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Zip | 30058-6635
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Country | US
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Telephone | 770-855-2199
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN251849
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License Number State | GA
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