Doctor Name: | DR. GARY EUGENE BROWN |
NPI Number: | 1225151129 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PH.D |
License Number: | P0000000475 |
Business Practice Address: | 302 Broadway St Martin, TN - 382372455 |
Business Phone Number: | 7315870600 |
Business Fax Number: | 7315870600 |
Mailing Address: | 790 Old Fulton Rd, MARTIN |
State: | TN |
Postal Code: | 382378244 |
Phone Number: | 7315872732 |
Fax Number: | 7315870600 |
NPI Enumeration Date: | 04/08/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TM1800X |
License Number: | P0000000475 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Mental Retardation & Developmental Disabilities |
Taxonomy Definition: |