=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629890090
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRITTANY PRIEST DC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/28/2024
-----------------------------------------------------
Last Update Date | 10/28/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 60 WHITLOCK PL SW STE A
-----------------------------------------------------
City | MARIETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30064-3172
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-726-0195
-----------------------------------------------------
Fax | 678-348-7272
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4501 CIRCLE 75 PKWY SE APT 1210
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30339-3990
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-787-4265
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CHIRO11298
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------