Healthcare Provider Details

I. General information

NPI: 1205810074
Provider Name (Legal Business Name): WILLIAM JUDE BROWN PHD, FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 VAN AALST BLVD
FORT BENNING GA
31905-2102
US

IV. Provider business mailing address

6600 VAN AALST BLVD
FORT BENNING GA
31905-2102
US

V. Phone/Fax

Practice location:
  • Phone: 762-408-0311
  • Fax:
Mailing address:
  • Phone: 762-408-0311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number229304
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: