Provider Demographics
NPI:1750890216
Name:BROWN, MARCUS DIONTE (LPN)
Entity type:Individual
Prefix:
First Name:MARCUS
Middle Name:DIONTE
Last Name:BROWN
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5003 WESLEY PROVIDENCE PKWY
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-6950
Mailing Address - Country:US
Mailing Address - Phone:502-310-9871
Mailing Address - Fax:
Practice Address - Street 1:5003 WESLEY PROVIDENCE PKWY
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30038-6950
Practice Address - Country:US
Practice Address - Phone:502-310-9871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN087881164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse