Provider Demographics
NPI:1912788480
Name:BROWN, CARL G JR
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:G
Last Name:BROWN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4887 ANDERSON ANTHONY RD
Mailing Address - Street 2:
Mailing Address - City:LEAVITTSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44430-9765
Mailing Address - Country:US
Mailing Address - Phone:234-600-2151
Mailing Address - Fax:
Practice Address - Street 1:4887 ANDERSON ANTHONY RD
Practice Address - Street 2:
Practice Address - City:LEAVITTSBURG
Practice Address - State:OH
Practice Address - Zip Code:44430-9765
Practice Address - Country:US
Practice Address - Phone:234-600-2151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHTJ612798374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide