Healthcare Provider Details

I. General information

NPI: 1629722376
Provider Name (Legal Business Name): CORI BETH SUTTON BROWN NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2022
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 N WESTBERRY ST
SYLVESTER GA
31791-2125
US

IV. Provider business mailing address

4196 HIGHWAY 62 412 STE A
HARDY AR
72542-8002
US

V. Phone/Fax

Practice location:
  • Phone: 229-463-7071
  • Fax: 229-463-7081
Mailing address:
  • Phone: 479-388-0446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN258271
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: