=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023201555
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TIFFANY D. BROWN O.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/17/2007
-----------------------------------------------------
Last Update Date | 04/15/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2427 GRESHAM RD SE
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30316-3709
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-743-6971
-----------------------------------------------------
Fax | 678-490-8224
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4480H S COBB DR SE STE 124
-----------------------------------------------------
City | SMYRNA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30080-6958
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-743-6971
-----------------------------------------------------
Fax | 770-743-8224
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 1547 576T
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 2395
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------