Healthcare Provider Details

I. General information

NPI: 1427202068
Provider Name (Legal Business Name): KATHERINE LEIGH BROWN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2008
Last Update Date: 01/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5887 GLENRIDGE DR SUITE 140
ATLANTA GA
30328-5574
US

IV. Provider business mailing address

190 CHURCHILL DRIVE
ATLANTA GA
30350-4503
US

V. Phone/Fax

Practice location:
  • Phone: 678-705-7341
  • Fax: 678-973-0578
Mailing address:
  • Phone: 678-977-1126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number002920
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: