Healthcare Provider Details

I. General information

NPI: 1336401900
Provider Name (Legal Business Name): TALITHA BROWN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2012
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 FAULK ST
MONROE NC
28112-5086
US

IV. Provider business mailing address

PO BOX 602658
CHARLOTTE NC
28260-2658
US

V. Phone/Fax

Practice location:
  • Phone: 704-289-3024
  • Fax:
Mailing address:
  • Phone: 336-716-2011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number2017-00360
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2017-00360
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: