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General NPI Number Information
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NPI Number | 1588755482
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Entity Type | Individual
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Provider Name | HAIDY M BROOKS PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 08/25/2021
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Provider Practice Location Address
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Address Line | 5885 GLENRIDGE DR STE 100
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City | ATLANTA
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State | GA
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Zip | 30328-5572
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Country | US
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Telephone | 188-890-8055
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Fax | 720-598-0440
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Provider Business Mailing Address
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Address Line | 55 WHITCHER STREET SUITE 350
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City | MARIETTA
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State | GA
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Zip | 30060-1129
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Country | US
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Telephone | 770-424-6893
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Fax | 770-424-9095
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 004751
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License Number State | GA
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