Provider Demographics
NPI:1538846092
Name:BRIMAH, GLADYS M
Entity type:Individual
Prefix:
First Name:GLADYS
Middle Name:M
Last Name:BRIMAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 COUNTRY CLUB DR STE 140
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7392
Mailing Address - Country:US
Mailing Address - Phone:770-415-5889
Mailing Address - Fax:770-415-5890
Practice Address - Street 1:225 COUNTRY CLUB DR STE 140
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7392
Practice Address - Country:US
Practice Address - Phone:770-415-5889
Practice Address - Fax:770-415-5890
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN250142363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty