Healthcare Provider Details

I. General information

NPI: 1750161733
Provider Name (Legal Business Name): ELIZABETH BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2023
Last Update Date: 10/05/2023
Certification Date: 10/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3103 CLAIRMONT RD NE STE B
BROOKHAVEN GA
30329-1043
US

IV. Provider business mailing address

3103 CLAIRMONT RD NE STE B
BROOKHAVEN GA
30329-1043
US

V. Phone/Fax

Practice location:
  • Phone: 404-636-1457
  • Fax: 404-636-7449
Mailing address:
  • Phone: 404-636-1457
  • Fax: 404-636-7449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: