Healthcare Provider Details

I. General information

NPI: 1336447358
Provider Name (Legal Business Name): DENISE BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2011
Last Update Date: 03/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 COMER AVE
COLUMBUS GA
31904-8725
US

IV. Provider business mailing address

812 MOUNTAIN RIDGE DR
WAVERLY HALL GA
31831-4018
US

V. Phone/Fax

Practice location:
  • Phone: 706-323-0174
  • Fax: 706-256-3264
Mailing address:
  • Phone: 706-325-2035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: