Provider Demographics
NPI:1679907612
Name:BROWN, JORETTA KINDRICK
Entity Type:Individual
Prefix:MRS
First Name:JORETTA
Middle Name:KINDRICK
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 1:1422 JOHN SMITH AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31903-2417
Mailing Address - Country:US
Mailing Address - Phone:706-604-5639
Mailing Address - Fax:
Practice Address - Street 1:1422 JOHN SMITH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31903-2417
Practice Address - Country:US
Practice Address - Phone:706-604-5639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-27
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator