Provider Demographics
NPI:1073519237
Name:BROWN, GEORGE W IV (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:W
Last Name:BROWN
Suffix:IV
Gender:M
Credentials:MD
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Mailing Address - Street 1:1000 CORPORATE CENTER DR
Mailing Address - Street 2:STE 200
Mailing Address - City:MORROW
Mailing Address - State:GA
Mailing Address - Zip Code:30260-4129
Mailing Address - Country:US
Mailing Address - Phone:770-968-6464
Mailing Address - Fax:770-968-6455
Practice Address - Street 1:1000 CORPORATE CENTER DR
Practice Address - Street 2:STE 200
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-4129
Practice Address - Country:US
Practice Address - Phone:770-968-6464
Practice Address - Fax:770-968-6455
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2019-10-29
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Provider Licenses
StateLicense IDTaxonomies
GA030275207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0358201Medicaid
GA08BDPBTMedicare PIN
GAD90983Medicare UPIN