MEDICARE: BRITAIN INGRAM

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	101YM0800X	Mental Health Counselor		GA

General Provider Information

NPI Number	:	1831755933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRITAIN INGRAM

Provider Business Mailing Address
First Line	:	195 LADY HELEN CT
Second Line	:
City	:	FAYETTEVILLE
State	:	GA
Zip	:	30214-3601
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2930 FORREST HILLS DR SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30315-9027
Country	:	US
Telephone Number	:	404-591-7275
Fax Number	:

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

Provider Enumeration Date	:	05/14/2019
Last Update Date	:	05/14/2019

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Directions to “ BRITAIN INGRAM ” Practice Location

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