Basic Information
| Provider Information | |||||||||
| NPI: | 1235694696 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TOLIVER | ||||||||
| FirstName: | BRITTANY | ||||||||
| MiddleName: | CLARKE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MSN, PMHNP- BC | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | CLARKE | ||||||||
| OtherFirstName: | BRITTANY | ||||||||
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| OtherCredential: | MSN, PMHNP- BC | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 123 SABLE VALLEY DR | ||||||||
| Address2: | |||||||||
| City: | ACWORTH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301027603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2569269439 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1000 JOHNSON FERRY RD | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4048518000 | ||||||||
| FaxNumber: | 4043033759 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2019 | ||||||||
| LastUpdateDate: | 11/07/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | RN233679 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.