Healthcare Provider Details

I. General information

NPI: 1033411343
Provider Name (Legal Business Name): BRITTANY MARIE GILLENWATER ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2010
Last Update Date: 11/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4020 SPRING CREEK LN
SANDY SPRINGS GA
30350-3833
US

IV. Provider business mailing address

4020 SPRING CREEK LN
SANDY SPRINGS GA
30350-3833
US

V. Phone/Fax

Practice location:
  • Phone: 770-395-1944
  • Fax:
Mailing address:
  • Phone: 770-395-1944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberAT001707
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: