MEDICARE: ALICIA BROWN BS, MSTD, M.S.ED.

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	174H00000X	Health Educator

General Provider Information

NPI Number	:	1215460837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALICIA BROWN BS, MSTD, M.S.ED.

Provider Business Mailing Address
First Line	:	PO BOX 857
Second Line	:
City	:	JEFFERSON
State	:	GA
Zip	:	30549-0857
Country	:	US
Telephone Number	:	706-983-9096
Fax Number	:

Provider Business Practice Location Address
First Line	:	716 E FAIRFIELD RD STE 121
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29605-3688
Country	:	US
Telephone Number	:	706-983-9096
Fax Number	:

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

Provider Enumeration Date	:	04/10/2017
Last Update Date	:	04/10/2017

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