Provider Demographics
NPI:1962889998
Name:MBROWN ENTERPRISE LLC
Entity type:Organization
Organization Name:MBROWN ENTERPRISE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-497-7510
Mailing Address - Street 1:1750 SHILOH RD NW
Mailing Address - Street 2:APT 134
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-6507
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1750 SHILOH RD NW
Practice Address - Street 2:APT 134
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-6507
Practice Address - Country:US
Practice Address - Phone:314-497-7510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-28
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health