Provider Demographics
NPI:1558573667
Name:AFOLABI-BROWN, NOLEEN C (CRNA)
Entity Type:Individual
Prefix:
First Name:NOLEEN
Middle Name:C
Last Name:AFOLABI-BROWN
Suffix:
Gender:F
Credentials:CRNA
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 551420
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33355-1420
Mailing Address - Country:US
Mailing Address - Phone:800-243-3839
Mailing Address - Fax:855-851-4405
Practice Address - Street 1:777 HEMLOCK ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-2102
Practice Address - Country:US
Practice Address - Phone:866-507-5244
Practice Address - Fax:855-851-4405
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN144533367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000870889AOtherPEACHSTATE CMO -MCCG
GA000870889AMedicaid
GA344273OtherWELLCARE CMO - MCCG
GA430056088OtherRAILROAD MCR - MCCG
GA430056088OtherRAILROAD MCR - MCCG
GA43ZCBFB128Medicare ID - Type UnspecifiedMCCG