MEDICARE: DR. KATRINA DANIELLE BROWN PHD

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	103TS0200X	School Psychologist

General Provider Information

NPI Number	:	1386367589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATRINA DANIELLE BROWN PHD

Provider Business Mailing Address
First Line	:	3278 MITCHELL BLVD
Second Line	:
City	:	MOODY
State	:	GA
Zip	:	31605
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3278 MITCHELL BLVD
Second Line	:
City	:	MOODY
State	:	GA
Zip	:	31605
Country	:	US
Telephone Number	:	229-257-3898
Fax Number	:

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

Provider Enumeration Date	:	09/22/2022
Last Update Date	:	09/22/2022

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