Healthcare Provider Details

I. General information

NPI: 1194285783
Provider Name (Legal Business Name): MICHAEL WALTER BROWN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2019
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 WALTON WAY
AUGUSTA GA
30901-2612
US

IV. Provider business mailing address

734 E 45TH ST APT 2
SAVANNAH GA
31405-2482
US

V. Phone/Fax

Practice location:
  • Phone: 706-774-5795
  • Fax:
Mailing address:
  • Phone: 706-631-9195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number92755
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: