Provider Demographics
NPI:1285825877
Name:BRITTINGHAM, KATHY MCCOLLOUGH (DMD)
Entity Type:Individual
Prefix:DR
First Name:KATHY
Middle Name:MCCOLLOUGH
Last Name:BRITTINGHAM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3742 WALTON WAY EXT
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907-2417
Mailing Address - Country:US
Mailing Address - Phone:706-860-4190
Mailing Address - Fax:706-650-8855
Practice Address - Street 1:3742 WALTON WAY EXT
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-2417
Practice Address - Country:US
Practice Address - Phone:706-860-4190
Practice Address - Fax:706-650-8855
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA98591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice