MRS. BRANTRIESA CLARK PA-C NPI 1659883684

NPI Information

NPI: 1659883684
Provider Name: MRS. BRANTRIESA CLARK, PA-C
Classification: Physician Assistant - 363AM0700X
Entity Type: Individual

Specialization: Medical

Organization: PEACHTREE IMMEDIATE CARE FP, LLC

PECOS Registration: Yes

Address:
1829 LAWRENCEVILLE HWY
DECATUR, GA
ZIP 30033
Phone: (404) 292-8335
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MRS. Brantriesa Clark, PA-C is a medical physician assistant in Decatur, GA with 7 years of experience. MRS. Brantriesa Clark, PA-C NPI is 1659883684. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

1829 LAWRENCEVILLE HWY
DECATUR, GA
ZIP 30033-728
Phone: (404) 292-8335

The NPI 1659883684 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 10/31/2017 and was last updated on 3/6/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363AM0700X	Physician Assistant	Medical	7631	GEORGIA	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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