Healthcare Provider Details

I. General information

NPI: 1043013683
Provider Name (Legal Business Name): BRANDI J BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2025
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 S 1ST ST
JESUP GA
31545-1171
US

IV. Provider business mailing address

102 S 1ST ST
JESUP GA
31545-1171
US

V. Phone/Fax

Practice location:
  • Phone: 912-588-1035
  • Fax:
Mailing address:
  • Phone: 912-588-1035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH036442
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: