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General NPI Number Information
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NPI Number | 1104687466
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Entity Type | Individual
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Provider Name | JERIEL CONSTATINE BROWN PMP, QP
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Gender | Male
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Dates
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Enumeration Date | 01/23/2024
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Last Update Date | 01/23/2024
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Provider Practice Location Address
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Address Line | 1800 FARMINGTON RD
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City | ROCKY MOUNT
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State | NC
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Zip | 27801-3028
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Country | US
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Telephone | 252-469-2223
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Fax |
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Provider Business Mailing Address
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Address Line | 4780 ASHFORD DUNWOODY RD STE 540
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City | ATLANTA
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State | GA
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Zip | 30338-5502
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Country | US
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Telephone | 252-469-2223
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State | NULL
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Taxonomy #2
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Taxonomy Code | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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License Number | RN282083
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License Number State | GA
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