Provider Demographics
NPI:1619669918
Name:BROWN & SCOTT INTEGRATED CLINICAL PRACTICE
Entity type:Organization
Organization Name:BROWN & SCOTT INTEGRATED CLINICAL PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIERRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-253-4870
Mailing Address - Street 1:1105 RUSSELL PKWY STE C
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-5586
Mailing Address - Country:US
Mailing Address - Phone:478-253-4870
Mailing Address - Fax:800-434-4196
Practice Address - Street 1:1105 RUSSELL PKWY STE C
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-5586
Practice Address - Country:US
Practice Address - Phone:478-253-4870
Practice Address - Fax:800-434-4196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health