Individual provider Active NPI

Laurel Wilson Brigham

  • Physical Therapist
  • Atlanta, GA
National Provider Identifier
1053078519
Registry record updated Mar 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT015676 Issued in GA
Practice address
857 Collier Rd NW Ste 1
Atlanta, GA 30318-2544
Phone
(404) 419-7760
Fax
(844) 740-7760
NPI assigned
Nov 19, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT015676 GA Primary

Addresses

Primary practice location

857 Collier Rd NW Ste 1
Atlanta, GA 30318-2544

Mailing address

6397 Lee Hwy
Chattanooga, TN 37421-2564

Other practice location 1

4825 Sugarloaf Pkwy Ste C
Lawrenceville, GA 30044-8800
Phone (678) 985-0238

Other practice location 2

1111 Lower Fayetteville Rd Ste 2000
Newnan, GA 30265-6506
Phone (770) 251-7284

Other practice location 3

2515 Fence Rd Ste 160
Dacula, GA 30019-2138
Phone (770) 237-2852

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211207000692 GA Practitioner - Physical Therapist in Private Practice 1557751567 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Atlanta Sport and Spine Physical TherapyGroup PAC ID 3779666185, 8 clinicians

Practice addresses (Care Compare)

857 Collier Rd NW
Suite 1
Atlanta, GA 30318-2544
Phone (770) 309-4308

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1637280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710460800000",
    "number": "1053078519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6397 LEE HWY",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374212564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "857 COLLIER RD NW STE 1",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303182544",
            "telephone_number": "404-419-7760",
            "fax_number": "844-740-7760"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4825 Sugarloaf Pkwy Ste C",
            "address_purpose": "LOCATION",
            "city": "Lawrenceville",
            "state": "GA",
            "postal_code": "300448800",
            "country_code": "US",
            "telephone_number": "678-985-0238",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1111 Lower Fayetteville Rd Ste 2000",
            "address_purpose": "LOCATION",
            "city": "Newnan",
            "state": "GA",
            "postal_code": "302656506",
            "country_code": "US",
            "telephone_number": "770-251-7284",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2515 Fence Rd Ste 160",
            "address_purpose": "LOCATION",
            "city": "Dacula",
            "state": "GA",
            "postal_code": "300192138",
            "country_code": "US",
            "telephone_number": "770-237-2852",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRIGHAM",
        "first_name": "LAUREL",
        "middle_name": "WILSON",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-11-19",
        "last_updated": "2024-03-15",
        "certification_date": "2024-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "PT015676",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.