Provider Demographics
NPI:1245716984
Name:BROWN BEST, SHANELLE
Entity type:Individual
Prefix:
First Name:SHANELLE
Middle Name:
Last Name:BROWN BEST
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 1:2701 SAMSUM RD SW
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-5318
Mailing Address - Country:US
Mailing Address - Phone:574-301-9136
Mailing Address - Fax:
Practice Address - Street 1:1775 PARKER RD SE STE 210
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-6654
Practice Address - Country:US
Practice Address - Phone:574-301-9136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-16
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW0077511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical