Organization Name: | BROWN FAMILY PRACTICE, LLC |
NPI Number: | 1013257633 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CRYSTAL L BROWN (PHYSICIAN) |
Mailing Address: | 701 Bluebird Blvd Fort Valley |
State: | GA US |
Postal Code: | 310305085 |
Phone Number: | 4788271971 |
Fax Number: | 4788271973 |
NPI Enumeration Date: | 02/19/2013 |
NPI Last Update Date: | 03/22/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | 036348 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |