Provider Demographics
NPI:1760261614
Name:BRETT, JUSTIN MARIUS
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:MARIUS
Last Name:BRETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1373 COMET IVES LN
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-2282
Mailing Address - Country:US
Mailing Address - Phone:770-330-6244
Mailing Address - Fax:
Practice Address - Street 1:1373 COMET IVES LN
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-2282
Practice Address - Country:US
Practice Address - Phone:770-330-6244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant