MEDICARE: CHARNISSA 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	104100000X	Social Worker

General Provider Information

NPI Number	:	1477091544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARNISSA BROWN

Provider Business Mailing Address
First Line	:	5044 DIXIE BARWICK RD
Second Line	:
City	:	BOSTON
State	:	GA
Zip	:	31626-6408
Country	:	US
Telephone Number	:	229-300-2880
Fax Number	:

Provider Business Practice Location Address
First Line	:	6589 DRY LAKE RD
Second Line	:
City	:	QUITMAN
State	:	GA
Zip	:	31643-5905
Country	:	US
Telephone Number	:	229-263-6947
Fax Number	:

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

Provider Enumeration Date	:	02/08/2017
Last Update Date	:	04/14/2026

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Directions to “ CHARNISSA BROWN ” Practice Location

Language	Start Address	Practice Location

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