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General NPI Number Information
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NPI Number | 1184760134
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Entity Type | Individual
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Provider Name | J FRED BROWN L.P.C.
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Gender | Male
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2654 RIVERVIEW RD
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City | MACON
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State | GA
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Zip | 31204-1122
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Country | US
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Telephone | 678-642-1310
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 293
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City | BOLINGBROKE
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State | GA
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Zip | 31004-0293
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Country | US
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Telephone | 678-642-1310
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Fax | 912-557-7633
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 1122
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License Number State | GA
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