Gary Brown

Key facts

NPI

1396200424

Entity type

Organization (NPI type 2)

Primary specialty

Intellectual & Developmental Disabilities Psychologist 103TM1800X

Legal business name

GARY BROWN

Practice address

302 Broadway St
Martin, TN 38237-2455

Phone

(731) 587-0600

Fax

(731) 587-0600

NPI assigned

Feb 2, 2019

Organization subpart

No

Authorized official

Name

Lisa Kay Page

Title

Credentialing Manager

Phone

(731) 693-3465

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Chasnie Thompson, M.S.CCC-SLP Speech-Language Pathologist · Martin, TN · NPI 1184115149
  NPD (past)

National Provider Directory

Locations

Specialties & licenses

Addresses

Other identifiers

Other names

• CHILDREN'S TREATMENT CENTER Doing business as

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Feb 2, 2019.

{
    "created_epoch": "1549065600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1549065600000",
    "number": "1396200424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "302 BROADWAY ST",
            "city": "MARTIN",
            "state": "TN",
            "postal_code": "382372455",
            "telephone_number": "731-587-0600",
            "fax_number": "731-587-0600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 BROADWAY ST",
            "city": "MARTIN",
            "state": "TN",
            "postal_code": "382372455",
            "telephone_number": "731-587-0600",
            "fax_number": "731-587-0600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GARY BROWN",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-02",
        "last_updated": "2019-02-02",
        "status": "A",
        "authorized_official_last_name": "PAGE",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "KAY",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "731-693-3465"
    },
    "taxonomies": [
        {
            "code": "103TM1800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Intellectual & Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q032646",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CHILDREN'S TREATMENT CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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