Healthcare Provider Details

I. General information

NPI: 1275693459
Provider Name (Legal Business Name): REAY H. BROWN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 08/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5730 GLENRIDGE DR NE SUITE120
ATLANTA GA
30328-6141
US

IV. Provider business mailing address

5730 GLENRIDGE DR NE SUITE120
ATLANTA GA
30328-6141
US

V. Phone/Fax

Practice location:
  • Phone: 404-252-1194
  • Fax: 404-252-3150
Mailing address:
  • Phone: 404-252-1194
  • Fax: 404-252-3150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number30728
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License Number30728
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: