Healthcare Provider Details

I. General information

NPI: 1720949654
Provider Name (Legal Business Name): BRITTANY GARDNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRITTANY MAE LENNERS RD

II. Dates (important events)

Enumeration Date: 11/20/2025
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 PEACHTREE ST NE
ATLANTA GA
30308-2212
US

IV. Provider business mailing address

1602 MASONS CREEK CIR
SANDY SPRINGS GA
30350-2566
US

V. Phone/Fax

Practice location:
  • Phone: 404-686-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD004718
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: