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General NPI Number Information
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NPI Number | 1255392346
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Entity Type | Individual
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Provider Name | TIMOTHY BONITTO BROWN M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/29/2006
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Last Update Date | 11/14/2011
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Provider Practice Location Address
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Address Line | 83 UPPER RIVERDALE ROAD SUITE 135
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City | RIVERDALE
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State | GA
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Zip | 30274
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Country | US
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Telephone | 770-991-0778
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Fax | 770-991-7390
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Provider Business Mailing Address
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Address Line | 83 UPPER RIVERDALE ROAD SUITE 135
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City | RIVERDALE
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State | GA
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Zip | 30274
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Country | US
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Telephone | 770-991-0778
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Fax | 770-991-7390
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 032110
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License Number State | GA
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