Provider Demographics
NPI:1083785380
Name:BRIM, SUSAN C (DR)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:C
Last Name:BRIM
Suffix:
Gender:F
Credentials:DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 598
Mailing Address - Street 2:1000 BRIM RD
Mailing Address - City:SASSER
Mailing Address - State:GA
Mailing Address - Zip Code:39885-0598
Mailing Address - Country:US
Mailing Address - Phone:229-698-5582
Mailing Address - Fax:
Practice Address - Street 1:400 N JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-2359
Practice Address - Country:US
Practice Address - Phone:229-435-8351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA14644183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist