Provider Demographics
NPI:1275954406
Name:BROWN, CEDRIC LEE
Entity Type:Individual
Prefix:MR
First Name:CEDRIC
Middle Name:LEE
Last Name:BROWN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:974 SISTRUNK CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31907-7425
Mailing Address - Country:US
Mailing Address - Phone:706-888-4805
Mailing Address - Fax:
Practice Address - Street 1:919 LAWYERS LN
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31906-3129
Practice Address - Country:US
Practice Address - Phone:706-888-4805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-13
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker