=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932374352
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BROWN FAMILY HEALTH CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/26/2008
-----------------------------------------------------
Last Update Date | 04/26/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4 SAVANNAH ST
-----------------------------------------------------
City | WINDER
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30680-2480
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-586-0017
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1479
-----------------------------------------------------
City | WINDER
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30680-6479
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-586-0017
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. EMMACARRIE G BROWN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 404-579-4349
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | 059377
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------