MEDICARE: JUANITA M BROWN DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	OS6343	FL
2	204D00000X	Neuromusculoskeletal Medicine & OMM Physician	OS6343	FL

General Provider Information

NPI Number	:	1134236201
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUANITA M BROWN DO

Provider Business Mailing Address
First Line	:	PO BOX 367
Second Line	:
City	:	HARROGATE
State	:	TN
Zip	:	37752-0367
Country	:	US
Telephone Number	:	423-869-7193
Fax Number	:	423-869-7195

Provider Business Practice Location Address
First Line	:	424 N BROAD ST
Second Line	:
City	:	NEW TAZEWELL
State	:	TN
Zip	:	37825-6606
Country	:	US
Telephone Number	:	423-869-7193
Fax Number	:	423-869-7195

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2006
Last Update Date	:	03/17/2018

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