Provider Demographics
NPI:1568786259
Name:BRIAN A. LEVITT, MD, LLC
Entity Type:Organization
Organization Name:BRIAN A. LEVITT, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEVITT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-904-7210
Mailing Address - Street 1:1700 TREE LN
Mailing Address - Street 2:SUITE #200
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-6782
Mailing Address - Country:US
Mailing Address - Phone:678-904-7210
Mailing Address - Fax:678-904-7217
Practice Address - Street 1:1700 TREE LN
Practice Address - Street 2:SUITE #200
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-6782
Practice Address - Country:US
Practice Address - Phone:678-904-7210
Practice Address - Fax:678-904-7217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-24
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00469103DMedicaid