Provider Demographics
NPI:1043022056
Name:BROWN, SHAQUETTA (CLD, CP, ICD)
Entity type:Individual
Prefix:
First Name:SHAQUETTA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:CLD, CP, ICD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 ROBERT C DANIEL JR PKWY # 1465
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-0803
Mailing Address - Country:US
Mailing Address - Phone:706-250-0249
Mailing Address - Fax:
Practice Address - Street 1:2118 ASHLEY DR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30906-5083
Practice Address - Country:US
Practice Address - Phone:813-629-2407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-25
Last Update Date:2025-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula