Provider Demographics
NPI:1891214656
Name:BROOKS, SAMMY LEE (MS ST)
Entity Type:Individual
Prefix:
First Name:SAMMY
Middle Name:LEE
Last Name:BROOKS
Suffix:
Gender:M
Credentials:MS ST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 BRANDON MILL CIR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-1260
Mailing Address - Country:US
Mailing Address - Phone:404-895-8163
Mailing Address - Fax:
Practice Address - Street 1:270 CARPENTER DR STE 400
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-4933
Practice Address - Country:US
Practice Address - Phone:678-460-0345
Practice Address - Fax:678-460-0350
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-13
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA052617117OtherDRIVERS LICENSE