MEDICARE: MRS. BRITTNEY HOLMES JACKSON MFT

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	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1598540668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BRITTNEY HOLMES JACKSON MFT

Provider Business Mailing Address
First Line	:	2997 HAVENWOOD WAY
Second Line	:
City	:	LITHONIA
State	:	GA
Zip	:	30038-5304
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	836 METROPOLITAN PKWY SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30310-2802
Country	:	US
Telephone Number	:	404-586-0180
Fax Number	:

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

Provider Enumeration Date	:	08/28/2023
Last Update Date	:	08/28/2023

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