Provider Demographics
NPI:1689222747
Name:BRC MEDHEALTH
Entity Type:Organization
Organization Name:BRC MEDHEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:R
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:APRN FNP-BC
Authorized Official - Phone:770-231-8568
Mailing Address - Street 1:1415 HIGHWAY 85 N STE 108
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-7738
Mailing Address - Country:US
Mailing Address - Phone:470-301-4563
Mailing Address - Fax:
Practice Address - Street 1:962 FOREST GLN
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30238-8829
Practice Address - Country:US
Practice Address - Phone:770-231-8568
Practice Address - Fax:678-489-2348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-30
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty