Provider Demographics
NPI:1093744112
Name:BRIONES, PRIMA (MD)
Entity Type:Individual
Prefix:
First Name:PRIMA
Middle Name:
Last Name:BRIONES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 REDMOND CIR NW
Mailing Address - Street 2:BUILDING 103 - CLINICAL DIRECTOR'S OFFICE
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1345
Mailing Address - Country:US
Mailing Address - Phone:706-295-6285
Mailing Address - Fax:
Practice Address - Street 1:1305 REDMOND CIR NW
Practice Address - Street 2:BUILDING 103 - CLINICAL DIRECTOR'S OFFICE
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1345
Practice Address - Country:US
Practice Address - Phone:706-295-6285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA179162084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAE27956Medicare UPIN
GA26BDBVSMedicare ID - Type Unspecified