Provider Demographics
NPI:1134181415
Name:SEXTON, BROOKI J (OTR)
Entity type:Individual
Prefix:
First Name:BROOKI
Middle Name:J
Last Name:SEXTON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:BROOKI
Other - Middle Name:J
Other - Last Name:SEXTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR
Mailing Address - Street 1:2228 STARLING ST
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4200
Mailing Address - Country:US
Mailing Address - Phone:912-264-3141
Mailing Address - Fax:912-264-6190
Practice Address - Street 1:2228 STARLING ST
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4200
Practice Address - Country:US
Practice Address - Phone:912-264-3141
Practice Address - Fax:912-264-6190
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3976174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA116505Medicare ID - Type UnspecifiedPROVIDER NUMBER