Healthcare Provider Details

I. General information

NPI: 1235475765
Provider Name (Legal Business Name): BRITTANY LIGHTSEY JOSEPH MS, RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2013
Last Update Date: 09/21/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1062 FORSYTH ST STE 2E
MACON GA
31201-8631
US

IV. Provider business mailing address

1062 FORSYTH ST STE 2E
MACON GA
31201-8631
US

V. Phone/Fax

Practice location:
  • Phone: 478-633-7330
  • Fax: 478-633-7360
Mailing address:
  • Phone: 478-633-7330
  • Fax: 478-633-7360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License NumberLD003984
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: