MEDICARE: TAMARA BROWN, MD, LLC

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	207R00000X	Internal Medicine Physician	040620	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DD6207	OTHER		RAILROAD MEDICARE

General Provider Information

NPI Number	:	1376602532
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAMARA BROWN, MD, LLC

Provider Business Mailing Address
First Line	:	PO BOX 310539
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	31131-0539
Country	:	US
Telephone Number	:	404-696-4141
Fax Number	:	404-696-4166

Provider Business Practice Location Address
First Line	:	5835 CAMPBELLTON ROAD SW
Second Line	:	SUITE 201
City	:	ATLANTA
State	:	GA
Zip	:	30331-8014
Country	:	US
Telephone Number	:	404-696-4141
Fax Number	:	404-696-4166

Authorized Official
Title or Position	:	OWNER
Name	:	TAMARA YVETTE BROWN
Credential	:	MD
Telephone Number	:	404-696-4141

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	11/19/2013

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