Healthcare Provider Details

I. General information

NPI: 1679517817
Provider Name (Legal Business Name): SANDRA H BROWN CNM, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 06/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1199 PRINCE AVE
ATHENS GA
30606-2797
US

IV. Provider business mailing address

2727 PACES FERRY ROAD SUITE 1-1100 (ATTENTION DENISE)
ATLANTA GA
30339-2185
US

V. Phone/Fax

Practice location:
  • Phone: 706-475-5700
  • Fax:
Mailing address:
  • Phone: 470-271-3421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberRN117303CNM
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF0804009
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: