Healthcare Provider Details

I. General information

NPI: 1689381691
Provider Name (Legal Business Name): MICHAEL ZACHARY BROWN LPN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2022
Last Update Date: 10/31/2022
Certification Date: 10/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 N BROADWAY ST
JOHNSON CITY TN
37601-3525
US

IV. Provider business mailing address

2403 BROWNS MILL RD APT 27
JOHNSON CITY TN
37604-1975
US

V. Phone/Fax

Practice location:
  • Phone: 423-588-9978
  • Fax:
Mailing address:
  • Phone: 931-409-6953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number99476
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number99476
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number99476
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: