Healthcare Provider Details

I. General information

NPI: 1003027434
Provider Name (Legal Business Name): MICHELLE RENEE BROWN N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 10/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 1ST ST
MACON GA
31201-2852
US

IV. Provider business mailing address

MERCER MEDICINE CREDENTIALING 1327 STADIUM DRIVE
MACON GA
31207-1302
US

V. Phone/Fax

Practice location:
  • Phone: 478-301-5930
  • Fax: 478-301-5932
Mailing address:
  • Phone: 478-301-2362
  • Fax: 478-301-2391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number067038
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: