Provider Demographics
NPI:1851610265
Name:BROWN, MATTIE MORRIS
Entity Type:Individual
Prefix:
First Name:MATTIE
Middle Name:MORRIS
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 1:3340 POPLAR
Mailing Address - Street 2:SUITE 221
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111
Mailing Address - Country:US
Mailing Address - Phone:901-323-7106
Mailing Address - Fax:901-323-7106
Practice Address - Street 1:3340 POPLAR
Practice Address - Street 2:SUITE 221
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38111
Practice Address - Country:US
Practice Address - Phone:901-323-7106
Practice Address - Fax:901-323-7106
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN110001797253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care