Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2081S0010X | Sports Medicine | 2547 | AL |
N | 213ES0000X | Sports Medicine | 2547 | AL |
NPI | 1568136687 |
---|---|
Provider Name | Brittany W Mathis |
First Address | Mcdonough, GA 30253-2927 |
Second Address | Auburn, AL 36849-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2021 |
Last Update Date | 03/08/2021 |