Healthcare Provider Details

I. General information

NPI: 1902850886
Provider Name (Legal Business Name): ANGELA M BROWN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 09/23/2022
Certification Date: 09/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3278 MITCHELL BLVD
MOODY AFB GA
31699-2227
US

IV. Provider business mailing address

3278 MITCHELL BLVD
MOODY AFB GA
31699-1500
US

V. Phone/Fax

Practice location:
  • Phone: 229-257-3898
  • Fax:
Mailing address:
  • Phone: 229-257-3898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number048606
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: