Provider Demographics
NPI:1073509279
Name:BROWN, CHARLES FREDERICK (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:FREDERICK
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:750 N COBB ST
Mailing Address - Street 2:SUITE 240
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-2390
Mailing Address - Country:US
Mailing Address - Phone:478-453-8511
Mailing Address - Fax:478-452-5458
Practice Address - Street 1:750 N COBB ST
Practice Address - Street 2:SUITE 240
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-2390
Practice Address - Country:US
Practice Address - Phone:478-453-8511
Practice Address - Fax:478-452-5458
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA26470207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000421572AMedicaid
F03573Medicare UPIN
16BDBLGMedicare ID - Type Unspecified