Healthcare Provider Details

I. General information

NPI: 1689587149
Provider Name (Legal Business Name): GERUNDA BROWN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 AUSTELL RD
AUSTELL GA
30106-1121
US

IV. Provider business mailing address

3950 AUSTELL RD
AUSTELL GA
30106-1121
US

V. Phone/Fax

Practice location:
  • Phone: 470-732-4119
  • Fax: 470-732-4119
Mailing address:
  • Phone: 470-732-4119
  • Fax: 470-732-4119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number141024
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: