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General NPI Number Information
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NPI Number | 1710940002
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Entity Type | Individual
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Provider Name | JESSIE EMMA BRUTUS-DARIUS M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/08/2006
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Last Update Date | 06/04/2020
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Provider Practice Location Address
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Address Line | 11 DUNWOODY PARK STE 190
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City | DUNWOODY
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State | GA
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Zip | 30338-7401
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Country | US
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Telephone | 770-558-3150
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Fax | 770-558-3511
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Provider Business Mailing Address
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Address Line | 11 DUNWOODY PARK STE 190
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City | DUNWOODY
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State | GA
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Zip | 30338-7401
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Country | US
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Telephone | 770-558-3150
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Fax | 770-558-3511
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 050135
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License Number State | GA
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