Healthcare Provider Details

I. General information

NPI: 1497091326
Provider Name (Legal Business Name): LINDSEY MICHELLE BROWN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LINDSEY BURGESS PA-C

II. Dates (important events)

Enumeration Date: 12/20/2012
Last Update Date: 01/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2118 SCENIC HWY N SUITE H
SNELLVILLE GA
30078-2633
US

IV. Provider business mailing address

2118 SCENIC HWY N SUITE H
SNELLVILLE GA
30078-2633
US

V. Phone/Fax

Practice location:
  • Phone: 770-558-6017
  • Fax:
Mailing address:
  • Phone: 770-558-6017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number7130
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2770
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: