Healthcare Provider Details

I. General information

NPI: 1801328794
Provider Name (Legal Business Name): BRITTANY ZOE BURDETT CSFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2017
Last Update Date: 05/04/2021
Certification Date: 05/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 POWDER SPRINGS ST
MARIETTA GA
30064-4883
US

IV. Provider business mailing address

1401 POWDER SPRINGS ST
MARIETTA GA
30064-4883
US

V. Phone/Fax

Practice location:
  • Phone: 770-658-6251
  • Fax:
Mailing address:
  • Phone: 770-658-6251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: