Provider Demographics
NPI:1033273693
Name:BROWN, JANELLA F (D,MD)
Entity Type:Individual
Prefix:
First Name:JANELLA
Middle Name:F
Last Name:BROWN
Suffix:
Gender:F
Credentials:D,MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 PUBLIC SQUARE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:KY
Mailing Address - Zip Code:42728
Mailing Address - Country:US
Mailing Address - Phone:270-384-3481
Mailing Address - Fax:270-385-9866
Practice Address - Street 1:318 PUBLIC SQUARE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:KY
Practice Address - Zip Code:42728
Practice Address - Country:US
Practice Address - Phone:270-384-3481
Practice Address - Fax:270-385-9866
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY691011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60069101Medicaid