MEDICARE: MRS. VUNTRESSA M BROWN MBA, R.T. (R)(T)(CT)

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	247100000X	Radiologic Technologist	352283	GA
2	2085R0001X	Radiation Oncology Physician	352283	GA
3	2471C3401X	Computed Tomography Radiologic Technologist	352283	GA
4	172A00000X	Driver	040817138	GA

General Provider Information

NPI Number	:	1669225579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VUNTRESSA M BROWN MBA, R.T. (R)(T)(CT)

Provider Business Mailing Address
First Line	:	1483 LAKE CITY INDUSTRIAL CT STE C
Second Line	:
City	:	MORROW
State	:	GA
Zip	:	30260-3544
Country	:	US
Telephone Number	:	404-882-7001
Fax Number	:

Provider Business Practice Location Address
First Line	:	1483 LAKE CITY INDUSTRIAL CT STE C
Second Line	:
City	:	MORROW
State	:	GA
Zip	:	30260-3544
Country	:	US
Telephone Number	:	404-882-7001
Fax Number	:

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

Provider Enumeration Date	:	04/10/2024
Last Update Date	:	04/10/2024

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