Provider Demographics
NPI:1700999760
Name:BROWN, LUDELLA (APRN NP-C)
Entity type:Individual
Prefix:MS
First Name:LUDELLA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:APRN NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 CANAL STREET SUITE 102
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-4258
Mailing Address - Country:US
Mailing Address - Phone:912-450-0998
Mailing Address - Fax:912-450-0999
Practice Address - Street 1:122 CANAL STREET SUITE 102
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-4258
Practice Address - Country:US
Practice Address - Phone:912-450-0998
Practice Address - Fax:912-450-0999
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN064864363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA153640219DMedicaid
SCNP0884Medicaid
GA153640219HMedicaid
GAP00418168OtherRR MEDICARE
GA153640219EMedicaid
GA50BBKNFMedicare PIN
GA153640219HMedicaid