Healthcare Provider Details

I. General information

NPI: 1174267264
Provider Name (Legal Business Name): BRITTANY JOI HARRIS CSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BRITTANY JOI HADLEY CSN

II. Dates (important events)

Enumeration Date: 04/25/2022
Last Update Date: 04/25/2022
Certification Date: 04/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 VILLA RD
BIRMINGHAM MI
48009-6587
US

IV. Provider business mailing address

1250 VILLA RD
BIRMINGHAM MI
48009-6587
US

V. Phone/Fax

Practice location:
  • Phone: 404-984-1019
  • Fax:
Mailing address:
  • Phone: 404-984-1019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: