MEDICARE: BROWN SUGAR HEALTH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency
2	261QM2500X	Medical Specialty Clinic/Center

General Provider Information

NPI Number	:	1013732940
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROWN SUGAR HEALTH LLC

Provider Business Mailing Address
First Line	:	507 BROMPTON LN
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-8208
Country	:	US
Telephone Number	:	818-515-7991
Fax Number	:

Provider Business Practice Location Address
First Line	:	507 BROMPTON LN
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-8208
Country	:	US
Telephone Number	:	818-515-7991
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. DERRICK WAYNE SMITH
Credential	:	MD
Telephone Number	:	818-515-7991

Provider Enumeration Date	:	11/15/2024
Last Update Date	:	06/06/2026

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