Healthcare Provider Details

I. General information

NPI: 1669933396
Provider Name (Legal Business Name): DONESHIA BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 03/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1436 SAINT ANDREWS LN
STARKVILLE MS
39759-1613
US

IV. Provider business mailing address

1436 SAINT ANDREWS LN
STARKVILLE MS
39759-1613
US

V. Phone/Fax

Practice location:
  • Phone: 662-694-2179
  • Fax: 662-332-4062
Mailing address:
  • Phone: 662-694-2179
  • Fax: 662-332-4062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1744G0900X
TaxonomyGraphics Designer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: