Provider Demographics
NPI:1164790622
Name:TOMBERLIN, BRITTNEY CRUMLEY (MEDCCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:BRITTNEY
Middle Name:CRUMLEY
Last Name:TOMBERLIN
Suffix:
Gender:F
Credentials:MEDCCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 MANASSAS PL
Mailing Address - Street 2:
Mailing Address - City:FITZGERALD
Mailing Address - State:GA
Mailing Address - Zip Code:31750-8666
Mailing Address - Country:US
Mailing Address - Phone:229-423-5493
Mailing Address - Fax:
Practice Address - Street 1:200 PERRY HOUSE RD
Practice Address - Street 2:
Practice Address - City:FITZGERALD
Practice Address - State:GA
Practice Address - Zip Code:31750-8857
Practice Address - Country:US
Practice Address - Phone:229-424-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP007488235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist