Healthcare Provider Details

I. General information

NPI: 1386429363
Provider Name (Legal Business Name): ANDREW BROWN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2023
Last Update Date: 08/29/2023
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

549 AMSTERDAM AVE NE STE 2
ATLANTA GA
30306-3472
US

IV. Provider business mailing address

549 AMSTERDAM AVE NE STE 2
ATLANTA GA
30306-3472
US

V. Phone/Fax

Practice location:
  • Phone: 404-532-1059
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT016815
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: