MEDICARE: BROWN & SCOTT INTEGRATED CLINICAL PRACTICE

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QM0850X	Adult Mental Health Clinic/Center
2	261QM0855X	Adolescent and Children Mental Health Clinic/Center
3	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1619669918
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROWN & SCOTT INTEGRATED CLINICAL PRACTICE

Provider Business Mailing Address
First Line	:	1105 RUSSELL PKWY STE C
Second Line	:
City	:	WARNER ROBINS
State	:	GA
Zip	:	31088-5586
Country	:	US
Telephone Number	:	478-253-4870
Fax Number	:	800-434-4196

Provider Business Practice Location Address
First Line	:	1105 RUSSELL PKWY STE C
Second Line	:
City	:	WARNER ROBINS
State	:	GA
Zip	:	31088-5586
Country	:	US
Telephone Number	:	478-253-4870
Fax Number	:	800-434-4196

Authorized Official
Title or Position	:	CO-OWNER
Name	:	MRS. KIERRA BROWN
Credential	:
Telephone Number	:	478-253-4870

Provider Enumeration Date	:	05/24/2023
Last Update Date	:	05/24/2023

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Directions to “BROWN & SCOTT INTEGRATED CLINICAL PRACTICE ” Practice Location

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