Healthcare Provider Details

I. General information

NPI: 1417375189
Provider Name (Legal Business Name): CLIFFORD SCOTT BROWN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2014
Last Update Date: 05/06/2021
Certification Date: 05/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5670 PEACHTREE DUNWOODY RD STE 1280
ATLANTA GA
30342-4792
US

IV. Provider business mailing address

5670 PEACHTREE DUNWOODY RD STE 1280
ATLANTA GA
30342-4792
US

V. Phone/Fax

Practice location:
  • Phone: 404-257-1589
  • Fax:
Mailing address:
  • Phone: 404-257-1589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number87853
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: