Healthcare Provider Details

I. General information

NPI: 1699327833
Provider Name (Legal Business Name): ANDREW BROWN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2019
Last Update Date: 05/06/2020
Certification Date: 05/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6640 POE AVE STE 100
DAYTON OH
45414-2678
US

IV. Provider business mailing address

1840 RICE BLVD
FAIRBORN OH
45324-3134
US

V. Phone/Fax

Practice location:
  • Phone: 937-617-2273
  • Fax: 937-387-9987
Mailing address:
  • Phone: 937-694-4545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2004787
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: