Basic Information
Provider Information
NPI: 1003009309
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BREWER
FirstName: DEBRA
MiddleName: BURNETT
NamePrefix: DR.
NameSuffix:  
Credential: AUD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: BREWER
OtherFirstName: DEBRA
OtherMiddleName: LYNN
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: AUD
OtherLastNameType: 1
Mailing Information
Address1: 1365 CLIFTON RD NE # A2334
Address2:  
City: ATLANTA
State: GA
PostalCode: 303221013
CountryCode: US
TelephoneNumber: 4047784441
FaxNumber: 4047784295
Practice Location
Address1: 1365 CLIFTON RD NE # A2334
Address2:  
City: ATLANTA
State: GA
PostalCode: 303221013
CountryCode: US
TelephoneNumber: 4047784441
FaxNumber: 4047784295
Other Information
ProviderEnumerationDate: 08/21/2007
LastUpdateDate: 08/21/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
231H00000XAUD001543GAY Speech, Language and Hearing Service ProvidersAudiologist 

No ID Information.


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