Jessilee Gabrielle Brooker, DMD
Individual provider Active NPI Dentist · Douglas, GA
NPI 1972128932 · NPPES record last updated Jun 15, 2020
Key facts
- NPI
- 1972128932
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- DNO16039 (GA)
- Practice address
- 1108 Madison Ave N
Douglas, GA 31533-2802 - Phone
- (912) 384-4432
- NPI assigned
- Jun 15, 2020
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DNO16039 | GA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| South Georgia Cosmetic & General Dentistry | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DNO16039 | GA | Yes |
Addresses
Primary practice location
1108 Madison Ave N
Douglas, GA 31533-2802
Mailing address
1108 Madison Ave N
Douglas, GA 31533-2802
Phone (912) 384-4432
Other providers in Douglas, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 15, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.