MEDICARE: WILLIAM KELLY BROWN LPC

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	101YM0800X	Mental Health Counselor
2	101YM0800X	Mental Health Counselor	008489	GA

General Provider Information

NPI Number	:	1295086924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM KELLY BROWN LPC

Provider Business Mailing Address
First Line	:	2250 N DRUID HILLS RD NE STE 135
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30329-3118
Country	:	US
Telephone Number	:	770-828-5441
Fax Number	:

Provider Business Practice Location Address
First Line	:	2250 N DRUID HILLS RD NE STE 135
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30329-3118
Country	:	US
Telephone Number	:	770-828-5441
Fax Number	:

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

Provider Enumeration Date	:	09/20/2012
Last Update Date	:	05/31/2023

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