Basic Information
Provider Information
NPI: 1538342209
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HIXON
FirstName: BRITTANY
MiddleName: ANNE
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 805 SANDY PLAINS ROAD
Address2: MEDICAL STAFF SERVICES
City: MARIETTA
State: GA
PostalCode: 300666340
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 677 CHURCH ST NE
Address2:  
City: MARIETTA
State: GA
PostalCode: 30060
CountryCode: US
TelephoneNumber: 7704221372
FaxNumber:  
Other Information
ProviderEnumerationDate: 12/17/2007
LastUpdateDate: 10/31/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
174400000X68640GAN Other Service ProvidersSpecialist 
207LC0200X68640GAN Allopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
207RC0200X68640GAY Allopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine

No ID Information.


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