Healthcare Provider Details

I. General information

NPI: 1154320505
Provider Name (Legal Business Name): DENNIS AUGUSTUS BROWN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1061 HARMON AVE WINN ARMY COMMUNITY HOSPITAL, PEDIATRIC CLINIC
FT STEWART GA
31314-5604
US

IV. Provider business mailing address

904 BACON RD
HINESVILLE GA
31313-4800
US

V. Phone/Fax

Practice location:
  • Phone: 912-435-5555
  • Fax: 912-435-5050
Mailing address:
  • Phone: 646-772-9500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number153831
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number051438
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: