Provider Demographics
NPI:1710940002
Name:BRUTUS-DARIUS, JESSIE EMMA (MD)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:EMMA
Last Name:BRUTUS-DARIUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 DUNWOODY PARK STE 190
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-7401
Mailing Address - Country:US
Mailing Address - Phone:770-558-3150
Mailing Address - Fax:770-558-3511
Practice Address - Street 1:11 DUNWOODY PARK STE 190
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-7401
Practice Address - Country:US
Practice Address - Phone:770-558-3150
Practice Address - Fax:770-558-3511
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA050135208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics