Healthcare Provider Details

I. General information

NPI: 1114673357
Provider Name (Legal Business Name): MARY MADISON BROWN M.S., BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2022
Last Update Date: 11/11/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2053 EXPERIMENT STATION RD
WATKINSVILLE GA
30677-5326
US

IV. Provider business mailing address

1055 BAXTER ST APT 308
ATHENS GA
30606-3777
US

V. Phone/Fax

Practice location:
  • Phone: 334-792-5020
  • Fax:
Mailing address:
  • Phone: 251-363-3835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-76894
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number22-204355
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: