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NPI 1609831957

NPI 1609831957 : GEORGE FULLER BRITT JR. ATC. : KENNESAW, GA

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General NPI Number Information
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    NPI Number           |    1609831957
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    Entity Type          |    Individual 
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    Provider Name        |    GEORGE FULLER BRITT JR. ATC.
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    Gender               |    Male 
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Dates
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    Enumeration Date     |    04/19/2006
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    Last Update Date     |    07/08/2007
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Provider Practice Location Address
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    Address Line         |    2985 GEORGE BUSBEE PARKWAY 
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    City                 |    KENNESAW
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    State                |    GA
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    Zip                  |    30144-6812
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    Country              |    US
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    Telephone            |    404-785-8008
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    Fax                  |    404-785-8003
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Provider Business Mailing Address
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    Address Line         |    3419 ENGLISH OAKS DRIVE 
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    City                 |    KENNESAW
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    State                |    GA
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    Zip                  |    30144-6034
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    Country              |    US
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    Telephone            |    404-314-1558
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    Fax                  |    
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Authorized Official
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    Title or Position    |    
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    Name                 |        
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    Credential           |    
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    Telephone            |    
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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    Taxonomy Code        |    2255A2300X
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    Taxonomy Name        |    Athletic Trainer
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    License Number       |    AT000636
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    License Number State |    GA
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