MEDICARE: MIA CHRISTINE BROWN CPHT

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	183700000X	Pharmacy Technician		GA

General Provider Information

NPI Number	:	1699362392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIA CHRISTINE BROWN CPHT

Provider Business Mailing Address
First Line	:	PO BOX 310771
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	31131-0771
Country	:	US
Telephone Number	:	404-343-5943
Fax Number	:

Provider Business Practice Location Address
First Line	:	2156 CHADWICK RD SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-5829
Country	:	US
Telephone Number	:	404-343-5943
Fax Number	:

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

Provider Enumeration Date	:	12/29/2020
Last Update Date	:	12/29/2020

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