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NPI Code Detail

MEDICARE: MRS. SUSAN PATRICE BROWN ANP-C

MEDICARE: MRS. SUSAN PATRICE BROWN ANP-C
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
1363LF0000XFamily Nurse PractitionerRN053925GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1390415OTHERGABLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1972595312
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SUSAN PATRICE BROWN ANP-C
Provider Business Mailing Address
First Line : 110 HOLLAND DR
Second Line :
City : JESUP
State : GA
Zip : 31546-2805
Country : US
Telephone Number : 912-427-2209
Fax Number :
Provider Business Practice Location Address
First Line : 303 FRASER DR
Second Line :
City : HINESVILLE
State : GA
Zip : 31313-3712
Country : US
Telephone Number : 912-877-2227
Fax Number : 912-877-2332
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/22/2005
Last Update Date : 05/15/2019

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