Provider Demographics
NPI:1528309408
Name:MIDDLEBROOKS, DIMESHA CARTER (FNP)
Entity type:Individual
Prefix:MRS
First Name:DIMESHA
Middle Name:CARTER
Last Name:MIDDLEBROOKS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1459 HARTFORD AVE SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30310-4218
Mailing Address - Country:US
Mailing Address - Phone:404-317-5032
Mailing Address - Fax:404-506-9584
Practice Address - Street 1:1459 HARTFORD AVE SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30310-4218
Practice Address - Country:US
Practice Address - Phone:404-317-5032
Practice Address - Fax:404-506-9584
Is Sole Proprietor?:No
Enumeration Date:2013-03-02
Last Update Date:2013-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN 165957363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily