Healthcare Provider Details

I. General information

NPI: 1073477014
Provider Name (Legal Business Name): BRITTNEY GOODEN CLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHAI SYRAH CLC

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5557 BRIDGE POINTE DR
ALPHARETTA GA
30005-4473
US

IV. Provider business mailing address

5557 BRIDGE POINTE DR
ALPHARETTA GA
30005-4473
US

V. Phone/Fax

Practice location:
  • Phone: 470-398-9788
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number359686
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: