Provider Demographics
NPI:1417433533
Name:JACOB, BRITTANY WHITLOCK (MD)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:WHITLOCK
Last Name:JACOB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4153B FLAT SHOALS PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-4189
Mailing Address - Country:US
Mailing Address - Phone:404-585-5049
Mailing Address - Fax:
Practice Address - Street 1:4153B FLAT SHOALS PKWY STE 200
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-4189
Practice Address - Country:US
Practice Address - Phone:404-585-5049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-11
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101188207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine