=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245909571
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BROWN SIGNATURE TRANSPORTATION AND MORE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/09/2021
-----------------------------------------------------
Last Update Date | 09/09/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3036 FELDWOOD CT
-----------------------------------------------------
City | LOCUST GROVE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30248-7221
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-410-0204
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 500 W FRANKLIN ST APT 1013
-----------------------------------------------------
City | MILLEDGEVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31061-5657
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-410-0204
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BUSINESS OWNER
-----------------------------------------------------
Name | MS. TEEAHDRA ALBERTA NATHELSA BROWN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 352-410-0204
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 347E00000X
-----------------------------------------------------
Taxonomy Name | Transportation Broker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------