Provider Demographics
NPI:1093938276
Name:BROWN, KEISHA (MD)
Entity Type:Individual
Prefix:DR
First Name:KEISHA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 ROCKBRIDGE RD
Mailing Address - Street 2:STE. 4
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-3138
Mailing Address - Country:US
Mailing Address - Phone:678-522-6086
Mailing Address - Fax:
Practice Address - Street 1:4426 HUGH HOWELL RD
Practice Address - Street 2:STE. B-332
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4918
Practice Address - Country:US
Practice Address - Phone:678-522-6086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0489852084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA832729777AMedicaid