Provider Demographics
NPI:1174154074
Name:BROWN, RODERICK B
Entity type:Individual
Prefix:MR
First Name:RODERICK
Middle Name:B
Last Name:BROWN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 PYRAMID PL STE 322
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38132-1703
Mailing Address - Country:US
Mailing Address - Phone:901-729-6237
Mailing Address - Fax:901-672-8520
Practice Address - Street 1:3592 KNIGHT ARNOLD RD STE 322
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38118-2709
Practice Address - Country:US
Practice Address - Phone:901-729-6237
Practice Address - Fax:901-672-8520
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-29
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN374U00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Yes374U00000XNursing Service Related ProvidersHome Health Aide