Provider Demographics
NPI:1053713537
Name:CHARLTON BROWN, RENEE ARNETTE
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:ARNETTE
Last Name:CHARLTON 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 1:89 ARCADIA DR
Mailing Address - Street 2:
Mailing Address - City:MIDWAY
Mailing Address - State:GA
Mailing Address - Zip Code:31320-3070
Mailing Address - Country:US
Mailing Address - Phone:912-877-4936
Mailing Address - Fax:
Practice Address - Street 1:89 ARCADIA DR
Practice Address - Street 2:
Practice Address - City:MIDWAY
Practice Address - State:GA
Practice Address - Zip Code:31320-3070
Practice Address - Country:US
Practice Address - Phone:912-877-4936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN169177163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care