Healthcare Provider Details

I. General information

NPI: 1508091844
Provider Name (Legal Business Name): THOMAS D BROWN JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2009
Last Update Date: 05/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 HOLLY DR
GAINESVILLE GA
30501-2110
US

IV. Provider business mailing address

826 HOLLY DR
GAINESVILLE GA
30501-2110
US

V. Phone/Fax

Practice location:
  • Phone: 770-534-9535
  • Fax:
Mailing address:
  • Phone: 770-534-9535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number009777
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: