Provider Demographics
NPI:1205635281
Name:BROWN, MIRACLE KAILYN
Entity type:Individual
Prefix:
First Name:MIRACLE
Middle Name:KAILYN
Last Name:BROWN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:MIRACLE
Other - Middle Name:KAILYN
Other - Last Name:DOCKERY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2700 HIGHWAY 34 E STE 100
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-2315
Mailing Address - Country:US
Mailing Address - Phone:470-394-0004
Mailing Address - Fax:
Practice Address - Street 1:2700 HIGHWAY 34 E STE 100
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-2315
Practice Address - Country:US
Practice Address - Phone:470-394-0004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician