Healthcare Provider Details

I. General information

NPI: 1063702900
Provider Name (Legal Business Name): BRITTANY PARK JEFFERS P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BRITTANY GAIL PARK

II. Dates (important events)

Enumeration Date: 04/12/2011
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 BILL CARRUTH PKWY STE 180
HIRAM GA
30141-3756
US

IV. Provider business mailing address

478 LINDBERGH PL NE APT 231
ATLANTA GA
30324-3313
US

V. Phone/Fax

Practice location:
  • Phone: 770-445-4915
  • Fax:
Mailing address:
  • Phone: 919-306-4963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number6118
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: