Provider Demographics
NPI:1073915336
Name:BROWN, GENESIS (MED CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:GENESIS
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:MISS
Other - First Name:GENESIS
Other - Middle Name:
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED CCC-SLP
Mailing Address - Street 1:105 BRYSON WAY
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-2012
Mailing Address - Country:US
Mailing Address - Phone:404-226-2888
Mailing Address - Fax:
Practice Address - Street 1:105 BRYSON WAY
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-2012
Practice Address - Country:US
Practice Address - Phone:404-226-2888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-18
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist