Healthcare Provider Details

I. General information

NPI: 1467945444
Provider Name (Legal Business Name): LYNETTE SINGLETON BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2018
Last Update Date: 06/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 VIRGINIA AVE
ATLANTA GA
30337-2841
US

IV. Provider business mailing address

1833 LANGSTON AVE SW
ATLANTA GA
30310-4946
US

V. Phone/Fax

Practice location:
  • Phone: 866-421-1388
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: