Healthcare Provider Details

I. General information

NPI: 1083119358
Provider Name (Legal Business Name): FREDERICK AFTON BROWN III
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2018
Last Update Date: 10/07/2022
Certification Date: 10/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 SOUTHLAND DR
MOBILE AL
36693-3313
US

IV. Provider business mailing address

5800 SOUTHLAND DR
MOBILE AL
36693-3313
US

V. Phone/Fax

Practice location:
  • Phone: 251-450-2211
  • Fax: 251-662-7297
Mailing address:
  • Phone: 251-450-2211
  • Fax: 251-662-7297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberOS18542
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberDO.2109
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: