Provider Demographics
NPI:1639837081
Name:BROWN, NADIRAH GERALDLYNN
Entity Type:Individual
Prefix:
First Name:NADIRAH
Middle Name:GERALDLYNN
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7130 HODGSON MEMORIAL DR STE 101
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-1527
Mailing Address - Country:US
Mailing Address - Phone:912-355-3881
Mailing Address - Fax:
Practice Address - Street 1:7130 HODGSON MEMORIAL DR STE 101
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-1527
Practice Address - Country:US
Practice Address - Phone:912-355-3881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-02
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC012540101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty