Healthcare Provider Details

I. General information

NPI: 1073751327
Provider Name (Legal Business Name): MR. DONALD E BROWN JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2009
Last Update Date: 03/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1503 WAYNE MEMORIAL DR SUITE H
GOLDSBORO NC
27534-2203
US

IV. Provider business mailing address

1503 WAYNE MEMORIAL DR SUITE H
GOLDSBORO NC
27534-2203
US

V. Phone/Fax

Practice location:
  • Phone: 919-330-4367
  • Fax: 919-330-4375
Mailing address:
  • Phone: 919-330-4367
  • Fax: 919-330-4375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberNC0033613
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: