Provider Demographics
NPI:1144535790
Name:DARK, BRITTAINY L (MD)
Entity type:Individual
Prefix:
First Name:BRITTAINY
Middle Name:L
Last Name:DARK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:761 OLD NORCROSS RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-4317
Mailing Address - Country:US
Mailing Address - Phone:770-513-4000
Mailing Address - Fax:770-995-7563
Practice Address - Street 1:761 OLD NORCROSS RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4317
Practice Address - Country:US
Practice Address - Phone:770-513-4000
Practice Address - Fax:770-995-7563
Is Sole Proprietor?:No
Enumeration Date:2010-08-06
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA64918207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
581397572OtherTAX ID #
GA997395956AMedicaid
GA581799397OtherMATERNAL GYNERATIONS PC
GA581799397OtherMATERNAL GYNERATIONS PC