Healthcare Provider Details

I. General information

NPI: 1891116448
Provider Name (Legal Business Name): TERRI BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2013
Last Update Date: 08/29/2023
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3540 WHEELER RD SUITE 203
AUGUSTA GA
30909-1871
US

IV. Provider business mailing address

3540 WHEELER RD SUITE 203
AUGUSTA GA
30909-1871
US

V. Phone/Fax

Practice location:
  • Phone: 706-922-9800
  • Fax: 706-922-9801
Mailing address:
  • Phone: 706-922-9800
  • Fax: 706-922-9801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number320085490
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: