Provider Demographics
NPI:1407994940
Name:BROWN, MILLICENT L (NP-C)
Entity Type:Individual
Prefix:MS
First Name:MILLICENT
Middle Name:L
Last Name:BROWN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MISS
Other - First Name:MILLICENT
Other - Middle Name:L
Other - Last Name:HENRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:3295 RIVER EXCHANGE DR
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-4241
Mailing Address - Country:US
Mailing Address - Phone:347-938-9246
Mailing Address - Fax:770-474-4620
Practice Address - Street 1:303 PERIMETER CTR N STE 300
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30346-3401
Practice Address - Country:US
Practice Address - Phone:347-938-9246
Practice Address - Fax:770-474-4620
Is Sole Proprietor?:No
Enumeration Date:2007-02-04
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF303967-1363LA2200X
NYF403183-01363LP0808X
GARN178172363LP0808X, 363LA2200X
NYF303967-01363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003239266AMedicaid
GA318335117BMedicaid
NYMH1232507OtherDEA
GAMH5982740OtherDEA
GA318335117BMedicaid