Healthcare Provider Details

I. General information

NPI: 1669304986
Provider Name (Legal Business Name): VERONICA BROWN
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 MIMOSA DR
MACON GA
31204-4313
US

IV. Provider business mailing address

1107 MIMOSA DR 1107 MIMOSA DR
MACON GA
31204-4313
US

V. Phone/Fax

Practice location:
  • Phone: 478-228-1607
  • Fax:
Mailing address:
  • Phone: 478-228-1607
  • Fax: 866-560-5161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: