Provider Demographics
NPI:1740630060
Name:BROWN, ANJANETTE NICOLE'
Entity type:Individual
Prefix:
First Name:ANJANETTE
Middle Name:NICOLE'
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANJANETTE
Other - Middle Name:NICOLE'
Other - Last Name:HOWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:706 WARRIORS RD
Mailing Address - Street 2:BUILDING 2115
Mailing Address - City:FORT STEWART
Mailing Address - State:GA
Mailing Address - Zip Code:31314
Mailing Address - Country:US
Mailing Address - Phone:912-767-4440
Mailing Address - Fax:912-767-0558
Practice Address - Street 1:706 WARRIORS RD
Practice Address - Street 2:BUILDING 2115
Practice Address - City:FORT STEWART
Practice Address - State:GA
Practice Address - Zip Code:31314
Practice Address - Country:US
Practice Address - Phone:912-767-4440
Practice Address - Fax:912-767-0558
Is Sole Proprietor?:No
Enumeration Date:2016-06-17
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA126800000X126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant