MEDICARE: JEANNE NICOLE EISENBROWN MD

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	208800000X	Urology Physician	ME84013	FL
2	208800000X	Urology Physician	CDR.0004775	CO
3	208800000X	Urology Physician	97508	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	:	1750376323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANNE NICOLE EISENBROWN MD

Provider Business Mailing Address
First Line	:	619 S 8TH ST STE 304
Second Line	:
City	:	GRIFFIN
State	:	GA
Zip	:	30224-4260
Country	:	US
Telephone Number	:	706-242-5201
Fax Number	:	706-242-5204

Provider Business Practice Location Address
First Line	:	619 S 8TH ST STE 304
Second Line	:
City	:	GRIFFIN
State	:	GA
Zip	:	30224-4260
Country	:	US
Telephone Number	:	706-242-5201
Fax Number	:	706-242-5204

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

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	08/18/2025

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