Healthcare Provider Details

I. General information

NPI: 1023481363
Provider Name (Legal Business Name): JENNIFER BROWN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2015
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3357B CORRIDOR MARKETPLACE
LAUREL MD
20724-2381
US

IV. Provider business mailing address

1050 EAGLES LANDING PKWY
STOCKBRIDGE GA
30281-9018
US

V. Phone/Fax

Practice location:
  • Phone: 301-497-1820
  • Fax:
Mailing address:
  • Phone: 404-778-8605
  • Fax: 404-251-2973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0009236
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number7833
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: