Healthcare Provider Details

I. General information

NPI: 1770806820
Provider Name (Legal Business Name): MARY JANE BROWN NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2010
Last Update Date: 08/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 JESSE JEWELL PKWY NE SUITE 300
GAINESVILLE GA
30501-3822
US

IV. Provider business mailing address

1315 JESSE JEWELL PKWY NE SUITE 300
GAINESVILLE GA
30501-3822
US

V. Phone/Fax

Practice location:
  • Phone: 770-219-6520
  • Fax:
Mailing address:
  • Phone: 770-219-6520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN074964
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9316494
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: