Provider Demographics
NPI:1265716518
Name:BROWN, JESSIQUE BISHOP (CLD, (CBI))
Entity type:Individual
Prefix:MRS
First Name:JESSIQUE
Middle Name:BISHOP
Last Name:BROWN
Suffix:
Gender:F
Credentials:CLD, (CBI)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1874 GRANDVIEW CIR SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30316-2324
Mailing Address - Country:US
Mailing Address - Phone:678-294-7206
Mailing Address - Fax:
Practice Address - Street 1:1874 GRANDVIEW CIR SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30316-2324
Practice Address - Country:US
Practice Address - Phone:678-294-7206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula