Provider Demographics
NPI:1134436942
Name:BRITTANYMANOR, INC
Entity type:Organization
Organization Name:BRITTANYMANOR, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ALBERTA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-304-3764
Mailing Address - Street 1:175 J D WALTON RD
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-4912
Mailing Address - Country:US
Mailing Address - Phone:770-304-3764
Mailing Address - Fax:770-304-3764
Practice Address - Street 1:175 J D WALTON RD
Practice Address - Street 2:175JDWALTON RD
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-4912
Practice Address - Country:US
Practice Address - Phone:770-304-3764
Practice Address - Fax:770-304-3764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health