Provider Demographics
NPI:1598100232
Name:FOX, BRITTANY TARA (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:BRITTANY
Middle Name:TARA
Last Name:FOX
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:PO BOX 80883
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30608-0883
Mailing Address - Country:US
Mailing Address - Phone:706-549-8114
Mailing Address - Fax:706-549-7558
Practice Address - Street 1:76 HIGHLAND PAVILION CT
Practice Address - Street 2:SUITE 133
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-3169
Practice Address - Country:US
Practice Address - Phone:770-439-1172
Practice Address - Fax:706-378-1204
Is Sole Proprietor?:No
Enumeration Date:2013-05-08
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA06780363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003136750EMedicaid