Organization
BROWN SUGAR HEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DERRICK WAYNE SMITH MD (CEO)
(818) 515-7991
Entity
Organization
Contact information
Practice address
7500 BANNER WAY NE, SEATTLE, WA 98115-4176
(318) 642-4909
Mailing address
507 BROMPTON LN, BOSSIER CITY, LA 71111-8208
(818) 515-7991
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
261QM2500X
Medical Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
11/15/2024
Last updated
11/15/2024
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