Provider Demographics
NPI:1194883371
Name:PRYOR BROWN, LANNIE JEWEL (PHD)
Entity type:Individual
Prefix:
First Name:LANNIE
Middle Name:JEWEL
Last Name:PRYOR BROWN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 BLYTH WALK
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-5923
Mailing Address - Country:US
Mailing Address - Phone:404-217-2821
Mailing Address - Fax:770-972-6101
Practice Address - Street 1:558 MEDLOCK RD STE 200
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-1512
Practice Address - Country:US
Practice Address - Phone:404-217-2821
Practice Address - Fax:770-972-6101
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001843103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical