1407994940 NPI number — DR. MILLICENT L BROWN PMHNP-BC

Table of content: DR. MILLICENT L BROWN PMHNP-BC (NPI 1407994940)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407994940 NPI number — DR. MILLICENT L BROWN PMHNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN
Provider First Name:
MILLICENT
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PMHNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HENRY
Provider Other First Name:
MILLICENT
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PMHNP-BC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1407994940
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/01/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5640 HALSEY TRCE SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30349-8755
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
347-938-9246
Provider Business Mailing Address Fax Number:
404-346-9510

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
212 5TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAY SHORE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11706-6408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-864-7560
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  F303967-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X , with the licence number: RN178172 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X , with the licence number: F303967-01 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: RN178172 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: F403183-01 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 318335117B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: F403183-01 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003239266A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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