Individual
JELANI BROWN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1833 MOUNT ZION RD, MORROW, GA 30260-3015
(917) 753-0777
Mailing address
1 CHESTNUT ST APT 118, PROVIDENCE, RI 02903-4123
(917) 753-0777
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DN122989
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
744531758-00
—
NY
Enumeration date
02/13/2021
Last updated
03/13/2023
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