Healthcare Provider Details

I. General information

NPI: 1619022985
Provider Name (Legal Business Name): LENNIS BROWN JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11231 RED SPRUCE DR
CHARLOTTE NC
28215-7607
US

IV. Provider business mailing address

11231 RED SPRUCE DR
CHARLOTTE NC
28215-7607
US

V. Phone/Fax

Practice location:
  • Phone: 704-535-8722
  • Fax: 704-535-2516
Mailing address:
  • Phone: 704-535-8722
  • Fax: 704-535-2516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHC3476
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: