Provider Demographics
NPI:1609555630
Name:KITTRELL, BRIAN PATRICK (CST, CSFA)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:PATRICK
Last Name:KITTRELL
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Gender:M
Credentials:CST, CSFA
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Mailing Address - Street 1:2537 CEDARCREST RD STE 305-14
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-8900
Mailing Address - Country:US
Mailing Address - Phone:470-336-8190
Mailing Address - Fax:770-336-6620
Practice Address - Street 1:2537 CEDARCREST RD STE 305-14
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-8900
Practice Address - Country:US
Practice Address - Phone:470-336-8190
Practice Address - Fax:770-336-6620
Is Sole Proprietor?:No
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
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Provider Licenses
StateLicense IDTaxonomies
GA213054363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical