Provider Demographics
NPI:1023187838
Name:TOM TARTT BROWN, JR., M.D.
Entity Type:Organization
Organization Name:TOM TARTT BROWN, JR., M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:TARTT
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:205-933-5808
Mailing Address - Street 1:2660 10TH AVE S
Mailing Address - Street 2:STE 225
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-1605
Mailing Address - Country:US
Mailing Address - Phone:205-933-5808
Mailing Address - Fax:205-930-2119
Practice Address - Street 1:2660 10TH AVE S
Practice Address - Street 2:STE 225
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1605
Practice Address - Country:US
Practice Address - Phone:205-933-5808
Practice Address - Fax:205-930-2119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAB9673129207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL110003757OtherMEDICARE RAILROAD
ALC73096Medicare UPIN