Provider Demographics
NPI:1689383556
Name:BROWN, CARLA MESHANNON (RN)
Entity Type:Individual
Prefix:MS
First Name:CARLA
Middle Name:MESHANNON
Last Name:BROWN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 THEBERTON TRL
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:GA
Mailing Address - Zip Code:30248-7407
Mailing Address - Country:US
Mailing Address - Phone:678-973-6864
Mailing Address - Fax:
Practice Address - Street 1:2050 THEBERTON TRL
Practice Address - Street 2:
Practice Address - City:LOCUST GROVE
Practice Address - State:GA
Practice Address - Zip Code:30248-7407
Practice Address - Country:US
Practice Address - Phone:678-973-6864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN288905163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty