Provider Demographics
NPI:1669225579
Name:BROWN, VUNTRESSA M (MBA, RT (R)(T)(CT))
Entity type:Individual
Prefix:MRS
First Name:VUNTRESSA
Middle Name:M
Last Name:BROWN
Suffix:
Gender:F
Credentials:MBA, RT (R)(T)(CT)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1483 LAKE CITY INDUSTRIAL CT STE C
Mailing Address - Street 2:
Mailing Address - City:MORROW
Mailing Address - State:GA
Mailing Address - Zip Code:30260-3544
Mailing Address - Country:US
Mailing Address - Phone:404-882-7001
Mailing Address - Fax:
Practice Address - Street 1:1483 LAKE CITY INDUSTRIAL CT STE C
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-3544
Practice Address - Country:US
Practice Address - Phone:404-882-7001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA352283247100000X, 2085R0001X, 2471C3401X
GA040817138172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
No247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist
No2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No2471C3401XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistComputed Tomography