Provider Demographics
NPI:1972850410
Name:MIMS, BRITTANY DAWN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:BRITTANY
Middle Name:DAWN
Last Name:MIMS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:BRITTANY
Other - Middle Name:DAWN
Other - Last Name:MIMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3213 ROGERS RD
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-3805
Practice Address - Country:US
Practice Address - Phone:919-562-2288
Practice Address - Fax:919-562-2225
Is Sole Proprietor?:No
Enumeration Date:2012-08-14
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-03690363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant