Provider Demographics
NPI:1376651422
Name:KENDRICK-BROWN, CARLA MARIE (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:MARIE
Last Name:KENDRICK-BROWN
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 546
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-0546
Mailing Address - Country:US
Mailing Address - Phone:229-928-3920
Mailing Address - Fax:229-928-3921
Practice Address - Street 1:100 PLANTATION RIDGE DRIVE
Practice Address - Street 2:SUITE D
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709
Practice Address - Country:US
Practice Address - Phone:229-928-3920
Practice Address - Fax:229-928-3921
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2015-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002730363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA100000160Medicaid
GAS18879Medicare UPIN