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General NPI Number Information
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NPI Number | 1114673357
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Entity Type | Individual
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Provider Name | MARY MADISON BROWN M.S., BCBA
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Gender | Female
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Dates
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Enumeration Date | 02/25/2022
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Last Update Date | 11/11/2024
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Provider Practice Location Address
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Address Line | 2053 EXPERIMENT STATION RD
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City | WATKINSVILLE
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State | GA
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Zip | 30677-5326
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Country | US
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Telephone | 334-792-5020
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Fax |
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Provider Business Mailing Address
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Address Line | 1055 BAXTER ST APT 308
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City | ATHENS
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State | GA
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Zip | 30606-3777
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Country | US
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Telephone | 251-363-3835
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | 22-204355
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-24-76894
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License Number State |
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