MEDICARE: MR. DONALD E BROWN JR.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator
2	2084A0401X	Addiction Medicine (Psychiatry & Neurology) Physician	NC0033613	NC
3	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1073751327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DONALD E BROWN JR.

Provider Business Mailing Address
First Line	:	1503 WAYNE MEMORIAL DR
Second Line	:	SUITE H
City	:	GOLDSBORO
State	:	NC
Zip	:	27534-2203
Country	:	US
Telephone Number	:	919-330-4367
Fax Number	:	919-330-4375

Provider Business Practice Location Address
First Line	:	1503 WAYNE MEMORIAL DR
Second Line	:	SUITE H
City	:	GOLDSBORO
State	:	NC
Zip	:	27534-2203
Country	:	US
Telephone Number	:	919-330-4367
Fax Number	:	919-330-4375

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2009
Last Update Date	:	03/16/2010

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