Provider Demographics
NPI:1881712719
Name:BROOKS, GEORGIA MARIE (RN)
Entity type:Individual
Prefix:MRS
First Name:GEORGIA
Middle Name:MARIE
Last Name:BROOKS
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 1:4065 CONGAREE DRIVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46235
Mailing Address - Country:US
Mailing Address - Phone:317-869-0156
Mailing Address - Fax:
Practice Address - Street 1:4065 CONGAREE DRIVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46235
Practice Address - Country:US
Practice Address - Phone:317-869-0156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28085743A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse