Healthcare Provider Details

I. General information

NPI: 1467446286
Provider Name (Legal Business Name): DERONDA FELICIA BROWN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DERONDA FELICIA PERSON M.D.

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 04/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1604 RIVER OAKS DR
RICHMOND HILL GA
31324-4587
US

IV. Provider business mailing address

106 E BROAD ST
SAVANNAH GA
31401-2917
US

V. Phone/Fax

Practice location:
  • Phone: 912-445-5183
  • Fax: 912-445-5183
Mailing address:
  • Phone: 912-527-1097
  • Fax: 912-527-1126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number050079
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: