Provider Demographics
NPI:1639772973
Name:GILLIS, BRITTANY FRANCIS
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:FRANCIS
Last Name:GILLIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 ERNEST BARRETT PKWY UNIT 5204
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-3544
Mailing Address - Country:US
Mailing Address - Phone:419-852-6043
Mailing Address - Fax:
Practice Address - Street 1:3700 MARTIN LUTHER KING JR DR SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-3674
Practice Address - Country:US
Practice Address - Phone:470-717-1438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker