MEDICARE: TASHAI T GILMAN-BROWN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LPC014518	GA
2	106S00000X	Behavior Technician
3	101YM0800X	Mental Health Counselor	LPC014518	GA

General Provider Information

NPI Number	:	1043822489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TASHAI T GILMAN-BROWN

Provider Business Mailing Address
First Line	:	PO BOX 452
Second Line	:
City	:	POWDER SPRINGS
State	:	GA
Zip	:	30127-0452
Country	:	US
Telephone Number	:	561-914-2707
Fax Number	:

Provider Business Practice Location Address
First Line	:	3723 GARDENWICK RD
Second Line	:
City	:	POWDER SPRINGS
State	:	GA
Zip	:	30127-5668
Country	:	US
Telephone Number	:	561-914-2707
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2020
Last Update Date	:	12/17/2024

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