Provider Demographics
NPI:1538825054
Name:BROWN, TRAVICIA LASHANDRA
Entity type:Individual
Prefix:
First Name:TRAVICIA
Middle Name:LASHANDRA
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TRAVICIA
Other - Middle Name:BROWN
Other - Last Name:LAKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1180 FRANKLIN GTWY SE STE 202
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8900
Mailing Address - Country:US
Mailing Address - Phone:504-814-1277
Mailing Address - Fax:
Practice Address - Street 1:1180 FRANKLIN GTWY SE STE 202
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8900
Practice Address - Country:US
Practice Address - Phone:504-814-1277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-09
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician
No246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical Laboratory
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider