=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568642569
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LORRAINE BROWN, D.O., P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/07/2007
-----------------------------------------------------
Last Update Date | 04/05/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1073 WOODLAND HWY STE B
-----------------------------------------------------
City | TALBOTTON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31827
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-252-9900
-----------------------------------------------------
Fax | 706-252-9901
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1073 WOODLAND HWY STE B
-----------------------------------------------------
City | TALBOTTON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31827
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-252-9900
-----------------------------------------------------
Fax | 706-252-9901
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | DR. LORRAINE BROWN
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 706-252-9900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 58152
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------