Healthcare Provider Details

I. General information

NPI: 1508770686
Provider Name (Legal Business Name): PORTIA M BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 W ROOSEVELT AVE # 219-B
ALBANY GA
31701-2640
US

IV. Provider business mailing address

235 W ROOSEVELT AVE # 219-B
ALBANY GA
31701-2640
US

V. Phone/Fax

Practice location:
  • Phone: 229-854-9852
  • Fax:
Mailing address:
  • Phone: 229-854-9852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: