Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 067038 | GA |
NPI | 1003027434 |
---|---|
Provider Name | Michelle Renee Brown |
First Address | Macon, GA 31207-1302 |
Second Address | Macon, GA 31201-2852 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2007 |
Last Update Date | 29/10/2014 |