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NPI Code Detail

MEDICARE: SAMMY LEE BROOKS MS ST

MEDICARE: SAMMY LEE BROOKS MS ST
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
1101YP1600XPastoral Counselor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1052617117OTHERGADRIVERS LICENSE

General Provider Information

NPI Number : 1891214656
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMMY LEE BROOKS MS ST
Provider Business Mailing Address
First Line : 365 BRANDON MILL CIR
Second Line :
City : FAYETTEVILLE
State : GA
Zip : 30214-1260
Country : US
Telephone Number : 404-895-8163
Fax Number :
Provider Business Practice Location Address
First Line : 270 CARPENTER DR STE 400
Second Line :
City : SANDY SPRINGS
State : GA
Zip : 30328-4933
Country : US
Telephone Number : 678-460-0345
Fax Number : 678-460-0350
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/13/2017
Last Update Date : 06/16/2018

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Directions to “ SAMMY LEE BROOKS MS ST” Practice Location

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