Sally Brumbill, P.A.

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

002152 Issued in GA

Practice address

880 Crestmark Dr Ste 200
Lithia Springs, GA 30122-2646

Phone

(770) 941-8662

Fax

(770) 739-6006

NPI assigned

Aug 11, 2005

Last updated

Feb 7, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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

• Douglas Womens Center PC

  • Obstetrics & Gynecology Physician
  • Lithia Springs, GA
  • NPI 1407840069
  NPD
• Amnestic, LLC

  • Anesthesiology Physician
  • Austell, GA
  • NPI 1407116056
  NPD (past)

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

{
    "created_epoch": "1123718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612656000000",
    "number": "1396747119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "880 CRESTMARK DR STE 200",
            "city": "LITHIA SPRINGS",
            "state": "GA",
            "postal_code": "301222646",
            "telephone_number": "770-941-8662",
            "fax_number": "770-739-6006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "880 CRESTMARK DR STE 200",
            "city": "LITHIA SPRINGS",
            "state": "GA",
            "postal_code": "301222646",
            "telephone_number": "770-941-8662",
            "fax_number": "770-739-6006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUMBILL",
        "first_name": "SALLY",
        "name_prefix": "Mrs.",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-11",
        "last_updated": "2021-02-07",
        "certification_date": "2021-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "GA",
            "license": "002152",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Richard Tyler Brock
• Richard Allen Brook, PHARMD
• Bryce Brown
• Jennifer Brown
• Brooke N Browning, PHARN D
• Tyrisa Burdine, SPECIALIST
• Brenda J Lipscomb Burgess, PT
• Claude Campbell Jr.
• Awana Carroll, PHARMD
• Felicia Rena Carter, CMA

• Medical Physician Assistant in Lithia Springs, GA
• Providers in Lithia Springs, GA by specialty
• Medical Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.