Provider Demographics
NPI:1740574516
Name:BROOKS, CHAD (MS, PA-C)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:BROOKS
Suffix:
Gender:M
Credentials:MS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 ALLENTOWN RD BLDG 763
Mailing Address - Street 2:
Mailing Address - City:ROBINS AFB
Mailing Address - State:GA
Mailing Address - Zip Code:31098-2252
Mailing Address - Country:US
Mailing Address - Phone:218-894-8687
Mailing Address - Fax:
Practice Address - Street 1:550 ALLENTOWN RD BLDG 763
Practice Address - Street 2:
Practice Address - City:ROBINS AFB
Practice Address - State:GA
Practice Address - Zip Code:31098-2252
Practice Address - Country:US
Practice Address - Phone:478-327-0365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-08
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2005363A00000X
GA10512363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
12256996OtherCAQH