Individual
NORMA BROCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNFA
Contact information
Practice address
807 E PONCE DE LEON AVE, DECATUR, GA 30030
(770) 853-1974
Mailing address
807 E PONCE DE LEON AVE, DECATUR, GA 30030-2036
(770) 853-1974
Taxonomy
Speciality
Code
Description
License number
State
163WR0006X
Registered Nurse First Assistant
Primary
RN080668
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RN080668
STATE LICENSE
GA
Enumeration date
02/22/2007
Last updated
07/19/2018
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