Provider Demographics
NPI:1124410766
Name:BROWN, GARRETT (LMBT)
Entity Type:Individual
Prefix:
First Name:GARRETT
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 CAROLINA ST
Mailing Address - Street 2:
Mailing Address - City:DOBSON
Mailing Address - State:NC
Mailing Address - Zip Code:27017-8846
Mailing Address - Country:US
Mailing Address - Phone:336-366-0236
Mailing Address - Fax:
Practice Address - Street 1:312 CAROLINA ST
Practice Address - Street 2:
Practice Address - City:DOBSON
Practice Address - State:NC
Practice Address - Zip Code:27017-8846
Practice Address - Country:US
Practice Address - Phone:336-366-0236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-18
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13665174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist