Healthcare Provider Details

I. General information

NPI: 1972049377
Provider Name (Legal Business Name): LIONEL BROWN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2017
Last Update Date: 10/07/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 WALTON WAY
AUGUSTA GA
30901-2612
US

IV. Provider business mailing address

211 ELLIOTT STREET
AMERICUS GA
31709
US

V. Phone/Fax

Practice location:
  • Phone: 706-737-9250
  • Fax:
Mailing address:
  • Phone: 229-591-8142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberRN208072
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number208072
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: