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NPI Code Detail

MEDICARE: MICHELLE BROWN BCBA

MEDICARE: MICHELLE BROWN BCBA
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
1103K00000XBehavior Analyst12042232GA

General Provider Information

NPI Number : 1972042802
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE BROWN BCBA
Provider Business Mailing Address
First Line : 632 WYNDHAM WAY
Second Line :
City : POOLER
State : GA
Zip : 31322-3623
Country : US
Telephone Number : 561-221-4343
Fax Number :
Provider Business Practice Location Address
First Line : 105 GRAND CENTRAL BLVD STE 101
Second Line :
City : POOLER
State : GA
Zip : 31322-4146
Country : US
Telephone Number : 912-388-1035
Fax Number : 912-525-0581
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/12/2017
Last Update Date : 09/08/2025

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Directions to “ MICHELLE BROWN BCBA” Practice Location

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