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General NPI Number Information
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NPI Number | 1073606513
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Entity Type | Individual
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Provider Name | THOMAS MATTHEW BROWN O.D.
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Gender | Male
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 01/27/2011
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Provider Practice Location Address
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Address Line | 840 GLYNN ST S SUITE 344
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-2004
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Country | US
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Telephone | 770-716-7414
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Fax | 770-716-7498
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Provider Business Mailing Address
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Address Line | 840 GLYNN ST S SUITE 344
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-2031
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Country | US
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Telephone | 770-716-7414
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Fax | 770-716-7498
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 002007
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License Number State | GA
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