Provider Demographics
NPI:1346528536
Name:RENFROE, BRITTANY WHEELER (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:BRITTANY
Middle Name:WHEELER
Last Name:RENFROE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:BRITTANY
Other - Middle Name:MICHELLE
Other - Last Name:WHEELER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 1038
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31902-1038
Mailing Address - Country:US
Mailing Address - Phone:706-660-2932
Mailing Address - Fax:706-660-2935
Practice Address - Street 1:2000 10TH AVE
Practice Address - Street 2:SUITE 320
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-3700
Practice Address - Country:US
Practice Address - Phone:706-660-2932
Practice Address - Fax:706-660-2935
Is Sole Proprietor?:No
Enumeration Date:2011-07-22
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006168363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003112155AMedicaid
GA202I977329Medicare PIN