Healthcare Provider Details

I. General information

NPI: 1215176920
Provider Name (Legal Business Name): SUSAN MCCLURE BROWNER M. DIV.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2009
Last Update Date: 02/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 GOLFVIEW RD NW
ATLANTA GA
30309-1214
US

IV. Provider business mailing address

405 GOLFVIEW RD NW
ATLANTA GA
30309-1214
US

V. Phone/Fax

Practice location:
  • Phone: 404-816-7171
  • Fax: 404-636-0849
Mailing address:
  • Phone: 404-816-7171
  • Fax: 404-636-0849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: