Provider Demographics
NPI:1972496537
Name:BROWN, SHEIRONE MARLYNE
Entity type:Individual
Prefix:
First Name:SHEIRONE
Middle Name:MARLYNE
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:767 STONEBRIDGE CRES
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-8264
Mailing Address - Country:US
Mailing Address - Phone:770-733-5170
Mailing Address - Fax:678-404-8214
Practice Address - Street 1:8024 ROCKBRIDGE RD
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-5882
Practice Address - Country:US
Practice Address - Phone:770-733-5170
Practice Address - Fax:678-404-8214
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1248836261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities