Healthcare Provider Details

I. General information

NPI: 1174688121
Provider Name (Legal Business Name): JAMES LEWIS BROWN JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 11/15/2022
Certification Date: 11/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 AUSTIN DR
DEMOREST GA
30535-4508
US

IV. Provider business mailing address

PO BOX 657
DEMOREST GA
30535-0657
US

V. Phone/Fax

Practice location:
  • Phone: 706-839-4092
  • Fax: 706-839-1970
Mailing address:
  • Phone: 706-839-4092
  • Fax: 706-839-1970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number21652
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number021652
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number21652
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: