Healthcare Provider Details

I. General information

NPI: 1003474867
Provider Name (Legal Business Name): JOSHUA ELIJAH BROWN NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2019
Last Update Date: 10/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 STONE HOGAN CONNECTOR RD SW STE B
ATLANTA GA
30331-2837
US

IV. Provider business mailing address

600 PHIPPS BLVD NE APT 2001
ATLANTA GA
30326-3349
US

V. Phone/Fax

Practice location:
  • Phone: 404-781-2800
  • Fax: 833-897-2947
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN271951
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN271951
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: