Provider Demographics
NPI:1801227772
Name:BROWN, VICTORIA NICOLE (CERTIFIED HAIR LOSS)
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:NICOLE
Last Name:BROWN
Suffix:
Gender:F
Credentials:CERTIFIED HAIR LOSS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1015 JERNIGAN ST
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:GA
Mailing Address - Zip Code:31069-3325
Mailing Address - Country:US
Mailing Address - Phone:478-224-7349
Mailing Address - Fax:478-224-7350
Practice Address - Street 1:1015 JERNIGAN ST
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069-3325
Practice Address - Country:US
Practice Address - Phone:478-224-7349
Practice Address - Fax:478-224-7350
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-03
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GAC00982261744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management