Provider Demographics
NPI:1003198995
Name:TYSON, BRITTNEY (PHARMD)
Entity Type:Individual
Prefix:
First Name:BRITTNEY
Middle Name:
Last Name:TYSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 NORTHSIDE DR NW
Mailing Address - Street 2:APT # 5502
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-2673
Mailing Address - Country:US
Mailing Address - Phone:404-388-8667
Mailing Address - Fax:
Practice Address - Street 1:4120 AUSTELL RD
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1841
Practice Address - Country:US
Practice Address - Phone:770-941-2918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH025670183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist