=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245250422
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DONALD FRANKLIN BROWN JR. ATC;LAT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 958 JOE FRANK HARRIS PKWY SE
-----------------------------------------------------
City | CARTERSVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30120-2158
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-387-8188
-----------------------------------------------------
Fax | 770-606-2110
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 306 REHOBOTH RD SW
-----------------------------------------------------
City | CAVE SPRING
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30124-2974
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-546-1273
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2255A2300X
-----------------------------------------------------
Taxonomy Name | Athletic Trainer
-----------------------------------------------------
License Number | 000179
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------