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General NPI Number Information
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NPI Number | 1942896774
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Entity Type | Individual
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Provider Name | BRIANNA NICOLE JEFFERSON
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Gender | Female
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Dates
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Enumeration Date | 12/16/2020
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Last Update Date | 12/16/2020
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Provider Practice Location Address
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Address Line | 3375 SPRING HILL PKWY SE APT 1034
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City | SMYRNA
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State | GA
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Zip | 30080-6837
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Country | US
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Telephone | 256-663-9172
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Fax |
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Provider Business Mailing Address
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Address Line | 8259 WICKER AVE
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City | SAINT JOHN
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State | IN
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Zip | 46373-8878
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Country | US
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Telephone |
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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 | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number | AT003789
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License Number State | GA
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