Provider Demographics
NPI:1174162945
Name:BROWN, CARLOS VERNON
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:VERNON
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 1:3801 GENTIAN BLVD APT 204
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31907-1167
Mailing Address - Country:US
Mailing Address - Phone:229-379-1453
Mailing Address - Fax:
Practice Address - Street 1:3801 GENTIAN BLVD APT 204
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31907-1167
Practice Address - Country:US
Practice Address - Phone:229-379-1453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-27
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator