Provider Demographics
NPI:1073174017
Name:BROWN, TAMIKA (DMD)
Entity Type:Individual
Prefix:
First Name:TAMIKA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 N PEACHTREE PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-4210
Mailing Address - Country:US
Mailing Address - Phone:770-268-9112
Mailing Address - Fax:
Practice Address - Street 1:1001 N PEACHTREE PKWY STE A
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-4210
Practice Address - Country:US
Practice Address - Phone:770-268-9112
Practice Address - Fax:770-631-0023
Is Sole Proprietor?:No
Enumeration Date:2019-06-20
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAAPPLIED1223G0001X
GADN016105122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice