MEDICARE: S TYRUS C BROWN PA

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	363A00000X	Physician Assistant	001914	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609843572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	S TYRUS C BROWN PA

Provider Business Mailing Address
First Line	:	132 FRANKLIN SPRINGS STREET
Second Line	:
City	:	ROYSTON
State	:	GA
Zip	:	30662
Country	:	US
Telephone Number	:	706-245-7371
Fax Number	:	706-245-9257

Provider Business Practice Location Address
First Line	:	132 FRANKLIN SPRINGS ST
Second Line	:
City	:	ROYSTON
State	:	GA
Zip	:	30662-4134
Country	:	US
Telephone Number	:	706-245-7371
Fax Number	:	706-245-9257

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

Provider Enumeration Date	:	03/01/2006
Last Update Date	:	03/03/2009

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Directions to “ S TYRUS C BROWN PA” Practice Location

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