MEDICARE: JERRY LEE BRITTAIN PH.D.

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	103G00000X	Clinical Neuropsychologist	0810001965	VA
2	103TC0700X	Clinical Psychologist	3897	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0810001965	OTHER	VA	VA LICENSE

General Provider Information

NPI Number	:	1972516367
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERRY LEE BRITTAIN PH.D.

Provider Business Mailing Address
First Line	:	703 E MOUNTAIN ST
Second Line	:
City	:	KERNERSVILLE
State	:	NC
Zip	:	27284
Country	:	US
Telephone Number	:	743-220-1484
Fax Number	:	743-220-1782

Provider Business Practice Location Address
First Line	:	703 E MOUNTAIN ST
Second Line	:
City	:	KERNERSVILLE
State	:	NC
Zip	:	27284
Country	:	US
Telephone Number	:	743-220-1484
Fax Number	:	743-220-1782

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

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	04/23/2026

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