Healthcare Provider Details

I. General information

NPI: 1942803846
Provider Name (Legal Business Name): BRITTANY MICHELE BUMGARNER H.I.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2020
Last Update Date: 11/21/2020
Certification Date: 11/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 HIGHWAY 400 S STE 525
DAWSONVILLE GA
30534-6894
US

IV. Provider business mailing address

800 HIGHWAY 400 S STE 525
DAWSONVILLE GA
30534-6894
US

V. Phone/Fax

Practice location:
  • Phone: 770-868-6036
  • Fax:
Mailing address:
  • Phone: 770-868-6036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHADS001007
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: