Healthcare Provider Details

I. General information

NPI: 1851482061
Provider Name (Legal Business Name): HARRIS RADCLIFF BROWN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 03/21/2022
Certification Date: 03/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 GEORGIAN DR STE A
MOBILE AL
36609
US

IV. Provider business mailing address

505 GEORGIAN DR STE A
MOBILE AL
36609
US

V. Phone/Fax

Practice location:
  • Phone: 251-342-1644
  • Fax: 251-342-1648
Mailing address:
  • Phone: 251-342-1644
  • Fax: 251-342-1648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number3572
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: