Healthcare Provider Details

I. General information

NPI: 1245239698
Provider Name (Legal Business Name): STANLEY JOE BROWN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 06/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5885 GLENRIDGE DR NE SUITE 200
SANDY SPRINGS GA
30328-5512
US

IV. Provider business mailing address

5885 GLENRIDGE DR NE SUITE 200
SANDY SPRINGS GA
30328-5512
US

V. Phone/Fax

Practice location:
  • Phone: 770-391-0552
  • Fax: 770-395-9344
Mailing address:
  • Phone: 770-391-0552
  • Fax: 770-395-9344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number37766
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: