1356948293 NPI number — MRS. BRITTANY MITCHELL MOMENT MS, RDN, LD

Table of content: MRS. BRITTANY MITCHELL MOMENT MS, RDN, LD (NPI 1356948293)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356948293 NPI number — MRS. BRITTANY MITCHELL MOMENT MS, RDN, LD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOMENT
Provider First Name:
BRITTANY
Provider Middle Name:
MITCHELL
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS, RDN, LD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MITCHELL
Provider Other First Name:
BRITTANY
Provider Other Middle Name:
MICHELLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1356948293
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/10/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
320 ZETA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TENNILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31089-1351
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-621-3499
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
114 S HARRIS ST # A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANDERSVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31082-1702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
478-209-6912
Provider Business Practice Location Address Fax Number:
833-740-4300
Provider Enumeration Date:
10/05/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  LD005680 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2026 www.npivalidator.com