MRS. BRANTRIESA CLARK (NPI# 1659883684) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659883684 |
| Entity Type | Individual |
| Full Name | MRS. BRANTRIESA CLARK |
| Other Name | MS. BRANTRIESA HUTCHINSON |
| Credential | PA-C |
| Practice Address |
1829 Lawrenceville Hwy Decatur GA 30033-5728 |
| Mailing Address |
60 Lotus Ln Covington GA 30016-1978 |
| Practice Telephone | 4042928335 |
| Mailing Telephone | 4049929254 |
| Enumeration Date | 2017-10-31 |
| Last Update Date | 2020-03-06 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
7631 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 5447 Dividend Dr, Lithonia, GA 300588412 | 7703228881 |
| Street Address |
1829 LAWRENCEVILLE HWY |
| City | DECATUR |
| State | GA |
| Zip Code | 30033-5728 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124013495 | Amina Hassanali | General Practice | 1829 Lawrenceville Hwy, Decatur, GA 30033-5728 | 2005-09-13 |
| 1710333257 | Daniel Keith Ralston | Family Medicine | 1829 Lawrenceville Hwy, Decatur, GA 30033-5728 | 2016-05-13 |
| 1992185573 | Smartcare, LLC | Clinic/Center | 1829 Lawrenceville Hwy, Decatur, GA 30033-5728 | 2015-06-09 |
| 1043526114 | Metro Medical Associates of Decatur, LLC | Internal Medicine | 1829 Lawrenceville Hwy, Decatur, GA 30033-5728 | 2010-08-26 |
| 1851606834 | Atlanta Metro Cardiology | Internal Medicine | 1829 Lawrenceville Hwy, Decatur, GA 30033-5728 | 2010-08-13 |
| 1700974805 | Abhay Trivedi | Internal Medicine | 1829 Lawrenceville Hwy, Decatur, GA 30033-5728 | 2006-10-11 |
| 1942228788 | Madhava R Koti | Emergency Medicine | 1829 Lawrenceville Hwy, Decatur, GA 30033-5728 | 2006-07-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922613785 | Healing Minds, Helping Hearts, LLC | Social Worker | 2532 N Decatur Rd, Apt 1304, Decatur, GA 30033 | 2020-09-09 |
| 1700412517 | Delana Finney | Orthotist | Vamc - Atlanta, 1670 Clairmont Rd, Decatur, GA 30033 | 2020-03-13 |
| 1194389353 | Katherine Serafen | Physician Assistant | 2701 N Decatur Road, Ground Floor Suite 520, Decatur, GA 30033 | 2019-04-23 |
| 1194290973 | Suzanne Johnson | Psychologist | Atlanta Va Health Care System, 1670 Clairmont Rd, Decatur, GA 30033 | 2018-10-09 |
| 1245705334 | Mcleod Counseling Services, LLC | Clinic/Center | 2801 N. Decatur Rd, Suite 185, Decatur, GA 30033 | 2018-10-04 |
| 1225514797 | Erkin Mirkhatovich Turganov | Pharmacist | 2951 Cedar Brook Dr, Decatur, GA 30033 | 2018-07-17 |
| 1356834972 | Sharlencia Lord | Nurse Practitioner | 2738 N Decatur Rd # 292-3173, Decatur, GA 30033 | 2018-06-08 |
| 1194213140 | Zacarias Yanis Jr. | Clinical Neuropsychologist | 1276 Mcconnell Drive Ste C., Decatur, GA 30033 | 2018-04-25 |
| 1780181370 | Ryan Patton | Orthopaedic Surgery | 2723 Hollywood Dr, Decatur, GA 30033 | 2018-04-10 |
| 1437669751 | Sholanda D Hooper | Nurse Practitioner | 1601 Clairmont Rd, Decatur, GA 30033 | 2017-10-02 |
| Find all providers in zip 30033 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487291878 | Ashley Cohen | Physician Assistant | 250 E Ponce De Leon Ave Ste 800, Decatur, GA 30030-3438 | 2019-12-04 |
| 1932757606 | Andrea J Holley | Physician Assistant | 1629 Austin Meadows Dr, Decatur, GA 30032-3888 | 2019-08-27 |
| 1073904181 | Nathan Potter | Physician Assistant | 798 Larry Ln, Decatur, GA 30033-4817 | 2015-02-11 |
| 1932467479 | Shannon L Hill | Physician Assistant | 1074 Ashbury Dr, Decatur, GA 30030-4165 | 2012-05-02 |
| 1578754792 | John Cicero Crawford II | Physician Assistant | 3941 John Hopkins Ct, Decatur, GA 30034-5709 | 2007-08-05 |
| 1437299773 | Barbar A Young | Physician Assistant | 3290 Memorial Dr Ste B3, Decatur, GA 30032-3400 | 2007-02-07 |
| 1992842595 | Veronica G Dockery | Physician Assistant | 346 N. Main St, Decatur, AR 72722-0735 | 2007-01-31 |
| 1649344938 | Telicia Dequai Scott | Physician Assistant | 4153b Flat Shoals Pkwy Ste 200, Decatur, GA 30034-4189 | 2006-11-20 |
| 1699773234 | Joanne Gilby Beer | Physician Assistant | 3292 Mountain Dr Ste A, Decatur, GA 30032-1102 | 2005-07-08 |
| 1871063263 | Paige Birge | Physician Assistant | 2300 N Edward St, Decatur, IL 62526-4163 | 2018-11-28 |
| Find all providers in DECATUR | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.