Provider Demographics
NPI:1285636977
Name:LEVITT, BRIAN (CSA)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:LEVITT
Suffix:
Gender:M
Credentials:CSA
Other - Prefix:DR
Other - First Name:BRIAN
Other - Middle Name:A
Other - Last Name:LEVITT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:7810 N SPALDING LAKE DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30350-1093
Mailing Address - Country:US
Mailing Address - Phone:678-904-7210
Mailing Address - Fax:770-394-5313
Practice Address - Street 1:7810 N SPALDING LAKE DR
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30350-1093
Practice Address - Country:US
Practice Address - Phone:678-904-7210
Practice Address - Fax:770-394-5313
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246ZC0007X
GA029485207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000469103CMedicaid
GA000469103DMedicaid
GAD30058Medicare UPIN
GA000469103CMedicaid