Provider Demographics
NPI:1104687466
Name:BROWN, JERIEL CONSTATINE (PMP, QP)
Entity type:Individual
Prefix:
First Name:JERIEL
Middle Name:CONSTATINE
Last Name:BROWN
Suffix:
Gender:M
Credentials:PMP, QP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4780 ASHFORD DUNWOODY RD STE 540
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-5502
Mailing Address - Country:US
Mailing Address - Phone:252-469-2223
Mailing Address - Fax:
Practice Address - Street 1:1800 FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27801-3028
Practice Address - Country:US
Practice Address - Phone:252-469-2223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN282083163WH0200X
374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No163WH0200XNursing Service ProvidersRegistered NurseHome Health