Healthcare Provider Details

I. General information

NPI: 1164290524
Provider Name (Legal Business Name): BRITNEY PITTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2023
Last Update Date: 03/24/2024
Certification Date: 03/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 WESTVIEW DR SW
ATLANTA GA
30310-1458
US

IV. Provider business mailing address

2998 TRIBUTARY WAY
DECATUR GA
30034-3257
US

V. Phone/Fax

Practice location:
  • Phone: 404-756-1383
  • Fax: 404-756-1313
Mailing address:
  • Phone: 516-417-3239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number058089416
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: