Provider Demographics
NPI:1063702900
Name:JEFFERS, BRITTANY PARK (PA)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:PARK
Last Name:JEFFERS
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:GAIL
Other - Last Name:PARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:478 LINDBERGH PL NE
Mailing Address - Street 2:APT 231
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-3313
Mailing Address - Country:US
Mailing Address - Phone:919-306-4963
Mailing Address - Fax:
Practice Address - Street 1:148 BILL CARRUTH PKWY STE 180
Practice Address - Street 2:
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-3756
Practice Address - Country:US
Practice Address - Phone:770-445-4915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-12
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
GA6118363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant