Healthcare Provider Details

I. General information

NPI: 1982059143
Provider Name (Legal Business Name): TARA BROWN D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2016
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

643 MAIN ST
PALMETTO GA
30268-1138
US

IV. Provider business mailing address

1850 BROOKS DR NW
ATLANTA GA
30318-2883
US

V. Phone/Fax

Practice location:
  • Phone: 770-463-4644
  • Fax:
Mailing address:
  • Phone: 404-931-3923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN015202
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: