Healthcare Provider Details
I. General information
NPI: 1649436569
Provider Name (Legal Business Name): AMANDA NICOLE BRITT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 07/30/2008
Last Update Date: 02/19/2021
Certification Date: 02/19/2021
Deactivation Date:
Reactivation Date:
III. Provider practice location address
2508 UNIVERSITY DR
THOMSON GA
30824-0040
US
IV. Provider business mailing address
315 FLUKER ST
THOMSON GA
30824-2108
US
V. Phone/Fax
- Phone: 706-595-1090
- Fax: 706-595-6010
- Phone: 706-595-1090
- Fax: 706-595-6010
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 208000000X |
| Taxonomy | Pediatrics Physician |
| License Number | 079634 |
| License Number State | GA |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 208000000X |
| Taxonomy | Pediatrics Physician |
| License Number | 125-054976 |
| License Number State | IL |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: