Basic Information
Provider Information
NPI: 1245671817
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BRITT
FirstName: ABBY
MiddleName: JOHANNA
NamePrefix: MRS.
NameSuffix:  
Credential: CNM
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 83 UPPER RIVERDALE RD SW STE 135
Address2:  
City: RIVERDALE
State: GA
PostalCode: 302742631
CountryCode: US
TelephoneNumber: 7709910778
FaxNumber: 7702104430
Practice Location
Address1: 83 UPPER RIVERDALE RD SW STE 135
Address2:  
City: RIVERDALE
State: GA
PostalCode: 302742631
CountryCode: US
TelephoneNumber: 7709910778
FaxNumber: 7702104430
Other Information
ProviderEnumerationDate: 07/11/2013
LastUpdateDate: 07/11/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367A00000XRN215985GAY Physician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife 

No ID Information.


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