Healthcare Provider Details

I. General information

NPI: 1245659713
Provider Name (Legal Business Name): CLARICE BROWN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2014
Last Update Date: 06/06/2022
Certification Date: 07/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 TULLIE RD NE FL 1
ATLANTA GA
30329-2309
US

IV. Provider business mailing address

1400 TULLIE RD NE FL 1
ATLANTA GA
30329-2309
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-5437
  • Fax: 404-785-9111
Mailing address:
  • Phone: 404-785-5437
  • Fax: 404-785-9111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number85651
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: