Healthcare Provider Details

I. General information

NPI: 1174917744
Provider Name (Legal Business Name): BRIAN N BREWER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2015
Last Update Date: 01/15/2024
Certification Date: 01/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2470 DANIELLS BRIDGE RD STE 231
ATHENS GA
30606-6188
US

IV. Provider business mailing address

PO BOX 48089
ATHENS GA
30604-8089
US

V. Phone/Fax

Practice location:
  • Phone: 706-769-3362
  • Fax: 706-769-5675
Mailing address:
  • Phone: 706-389-3727
  • Fax: 706-389-3951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number84383
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: