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NPI Code Detail

MEDICARE: MRS. SALLY BRUMBILL P.A.

MEDICARE: MRS. SALLY BRUMBILL P.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician Assistant002152GA

General Provider Information

NPI Number : 1396747119
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SALLY BRUMBILL P.A.
Provider Business Mailing Address
First Line : 880 CRESTMARK DR STE 200
Second Line :
City : LITHIA SPRINGS
State : GA
Zip : 30122-2646
Country : US
Telephone Number : 770-941-8662
Fax Number : 770-739-6006
Provider Business Practice Location Address
First Line : 880 CRESTMARK DR STE 200
Second Line :
City : LITHIA SPRINGS
State : GA
Zip : 30122-2646
Country : US
Telephone Number : 770-941-8662
Fax Number : 770-739-6006
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2005
Last Update Date : 02/07/2021

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Directions to “ MRS. SALLY BRUMBILL P.A.” Practice Location

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