Healthcare Provider Details

I. General information

NPI: 1093647356
Provider Name (Legal Business Name): CHRISTINA BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

699 CHURCH ST NE
MARIETTA GA
30060-1110
US

IV. Provider business mailing address

260 WHISPERWOOD LN NW
MARIETTA GA
30064-1665
US

V. Phone/Fax

Practice location:
  • Phone: 229-339-4732
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number162087
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: