MEDICARE: BRITTANY WHITLOCK JACOB MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	101188	GA

General Provider Information

NPI Number	:	1417433533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRITTANY WHITLOCK JACOB MD

Provider Business Mailing Address
First Line	:	4153B FLAT SHOALS PKWY STE 200
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30034-4189
Country	:	US
Telephone Number	:	404-585-5049
Fax Number	:

Provider Business Practice Location Address
First Line	:	4153B FLAT SHOALS PKWY STE 200
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30034-4189
Country	:	US
Telephone Number	:	404-585-5049
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2018
Last Update Date	:	08/29/2024

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