Healthcare Provider Details

I. General information

NPI: 1003127218
Provider Name (Legal Business Name): REGINA BRAXTON BRAY BROWN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2010
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 N. JOHNSON STREET
COATS NC
27521
US

IV. Provider business mailing address

60 CAPITAL DR
CHILLICOTHEE OH
45601-1186
US

V. Phone/Fax

Practice location:
  • Phone: 910-897-6423
  • Fax: 910-897-2540
Mailing address:
  • Phone: 740-779-4100
  • Fax: 740-779-4149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2018-02329
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.122200
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0116022791
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: