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General NPI Number Information
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NPI Number | 1407620255
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Entity Type | Individual
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Provider Name | TREVOR DERMAINE BROWN
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Gender | Male
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Dates
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Enumeration Date | 11/13/2023
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Last Update Date | 11/23/2025
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Provider Practice Location Address
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Address Line | 1777 MONTREAL CIR
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City | TUCKER
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State | GA
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Zip | 30084-6802
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Country | US
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Telephone | 866-697-8378
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Fax |
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Provider Business Mailing Address
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Address Line | 457 COLLIER RIDGE DR NW
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City | ATLANTA
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State | GA
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Zip | 30318-7311
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Country | US
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Telephone | 843-312-3381
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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 | 246QM0706X
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Taxonomy Name | Medical Technologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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