Provider Demographics
NPI:1679377436
Name:BROOKS, DAVID JERMAINE (RBT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:JERMAINE
Last Name:BROOKS
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 TREEVIEW DR APT D
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-1392
Mailing Address - Country:US
Mailing Address - Phone:423-544-2461
Mailing Address - Fax:
Practice Address - Street 1:505 COURTLAND ST NE UNIT 916
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2424
Practice Address - Country:US
Practice Address - Phone:423-544-2461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-02
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT025-422008106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician