Healthcare Provider Details

I. General information

NPI: 1558615021
Provider Name (Legal Business Name): CAMILLE J BROWN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2012
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11555 MEDLOCK BRIDGE RD STE 100
JOHNS CREEK GA
30097-3200
US

IV. Provider business mailing address

11555 MEDLOCK BRIDGE RD STE 100
JOHNS CREEK GA
30097-3200
US

V. Phone/Fax

Practice location:
  • Phone: 470-877-4102
  • Fax:
Mailing address:
  • Phone: 470-877-4102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN163812
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: