Provider Demographics
NPI:1942928668
Name:MATHIS, BRITTANY JANE (PA)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:JANE
Last Name:MATHIS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:JANE
Other - Last Name:YACAVONE-MCELVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:222 COLONIAL HOMES DR NW UNIT 2122
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1622
Mailing Address - Country:US
Mailing Address - Phone:504-913-1136
Mailing Address - Fax:
Practice Address - Street 1:95 COLLIER RD NW STE 2065
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1705
Practice Address - Country:US
Practice Address - Phone:404-605-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-18
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
GA11231363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant