Provider Demographics
NPI:1699486068
Name:BROWNLEE, KIM
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:BROWNLEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1432 GREEN ST APT C
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31601-7526
Mailing Address - Country:US
Mailing Address - Phone:917-463-7443
Mailing Address - Fax:
Practice Address - Street 1:1432 GREEN ST APT C
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31601-7526
Practice Address - Country:US
Practice Address - Phone:917-463-7443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor