Provider Demographics
NPI:1669648952
Name:BRODIE, CLARICE ANN (RN)
Entity Type:Individual
Prefix:
First Name:CLARICE
Middle Name:ANN
Last Name:BRODIE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 HICKORY DR
Mailing Address - Street 2:
Mailing Address - City:THOMASTON
Mailing Address - State:GA
Mailing Address - Zip Code:30286-7102
Mailing Address - Country:US
Mailing Address - Phone:706-647-6210
Mailing Address - Fax:
Practice Address - Street 1:605 W GORDON ST
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:GA
Practice Address - Zip Code:30286-3425
Practice Address - Country:US
Practice Address - Phone:706-646-6040
Practice Address - Fax:706-646-6039
Is Sole Proprietor?:No
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN067528163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse