MEDICARE: CHANDRA BROWN

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	225700000X	Massage Therapist	MT012969	GA

General Provider Information

NPI Number	:	1023941473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANDRA BROWN

Provider Business Mailing Address
First Line	:	4120 BEAVER RUN RD
Second Line	:
City	:	VALDOSTA
State	:	GA
Zip	:	31601-0712
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4120 BEAVER RUN RD
Second Line	:
City	:	VALDOSTA
State	:	GA
Zip	:	31601-0712
Country	:	US
Telephone Number	:	702-802-9160
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2026
Last Update Date	:	06/05/2026

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Directions to “ CHANDRA BROWN ” Practice Location

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