MEDICARE: SONYA BRITTING GREEN PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	004259	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861497786
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SONYA BRITTING GREEN PA-C

Provider Business Mailing Address
First Line	:	2701 N DECATUR RD
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30033-5918
Country	:	US
Telephone Number	:	404-501-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	2701 N DECATUR RD
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30033-5918
Country	:	US
Telephone Number	:	404-501-1000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	12/12/2011

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