Healthcare Provider Details

I. General information

NPI: 1154890564
Provider Name (Legal Business Name): SIDNEY ADELE BROWN-CAGGIANO PA-C, MPAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SIDNEY BROWN CAGGIANO PA

II. Dates (important events)

Enumeration Date: 11/14/2018
Last Update Date: 05/19/2020
Certification Date: 05/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4645 TIMBER RIDGE DR STE 100
DOUGLASVILLE GA
30135-7542
US

IV. Provider business mailing address

4645 TIMBER RIDGE DR STE 100
DOUGLASVILLE GA
30135-7542
US

V. Phone/Fax

Practice location:
  • Phone: 706-223-1235
  • Fax: 706-568-2705
Mailing address:
  • Phone: 706-223-1235
  • Fax: 706-568-2705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number009055
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: