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General NPI Number Information
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NPI Number | 1861812588
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Entity Type | Individual
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Provider Name | DR. SHALEAK BROWN
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Gender | Male
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Dates
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Enumeration Date | 04/21/2014
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Last Update Date | 04/14/2022
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Provider Practice Location Address
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Address Line | 6875 DOUGLAS BLVD
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City | DOUGLASVILLE
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State | GA
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Zip | 30135
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Country | US
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Telephone | 404-365-0966
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Fax |
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Provider Business Mailing Address
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Address Line | 1512 TIMBER RIDGE LN APT 101
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City | HYATTSVILLE
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State | MD
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Zip | 20782-2412
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Country | US
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Telephone | 219-314-0050
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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 | 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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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 080095
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License Number State | GA
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