Healthcare Provider Details

I. General information

NPI: 1134236201
Provider Name (Legal Business Name): JUANITA M BROWN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 N BROAD ST
NEW TAZEWELL TN
37825-6606
US

IV. Provider business mailing address

PO BOX 367
HARROGATE TN
37752-0367
US

V. Phone/Fax

Practice location:
  • Phone: 423-869-7193
  • Fax: 423-869-7195
Mailing address:
  • Phone: 423-869-7193
  • Fax: 423-869-7195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS6343
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberOS6343
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: