Healthcare Provider Details

I. General information

NPI: 1346102068
Provider Name (Legal Business Name): OTIS JAMES BROWN CAP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TONY BROWN

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

984 BOSTON HWY
MONTICELLO FL
32344-4758
US

IV. Provider business mailing address

207 WINTER WOOD LN # A
THOMASVILLE GA
31757-1252
US

V. Phone/Fax

Practice location:
  • Phone: 850-935-3637
  • Fax:
Mailing address:
  • Phone: 229-977-1818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCAP.0100641
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: