Provider Demographics
NPI:1043822489
Name:GILMAN-BROWN, TASHAI T
Entity type:Individual
Prefix:
First Name:TASHAI
Middle Name:T
Last Name:GILMAN-BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TASHAI
Other - Middle Name:T
Other - Last Name:GILMAN-BROWN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 452
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-0452
Mailing Address - Country:US
Mailing Address - Phone:561-914-2707
Mailing Address - Fax:
Practice Address - Street 1:3723 GARDENWICK RD
Practice Address - Street 2:
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-5668
Practice Address - Country:US
Practice Address - Phone:561-914-2707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC014518101YP2500X, 101YM0800X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician