MEDICARE: MR. EDDIE LORENZO BROWN SR. DRIVER

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	172A00000X	Driver

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	:	1649604943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EDDIE LORENZO BROWN SR. DRIVER

Provider Business Mailing Address
First Line	:	127 DEAN DR
Second Line	:
City	:	CLARKSVILLE
State	:	TN
Zip	:	37040-3981
Country	:	US
Telephone Number	:	931-278-7408
Fax Number	:	931-906-9477

Provider Business Practice Location Address
First Line	:	127 DEAN DR
Second Line	:
City	:	CLARKSVILLE
State	:	TN
Zip	:	37040-3981
Country	:	US
Telephone Number	:	931-278-7408
Fax Number	:	931-906-9477

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

Provider Enumeration Date	:	08/22/2013
Last Update Date	:	08/22/2013

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Directions to “ MR. EDDIE LORENZO BROWN SR. DRIVER” Practice Location

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