Provider Demographics
NPI:1073612339
Name:GENTA MEDICAL CLINIC P.C.
Entity Type:Organization
Organization Name:GENTA MEDICAL CLINIC P.C.
Other - Org Name:JOHN O. BROWB, M.D.
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:OSCAR
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-435-2895
Mailing Address - Street 1:1460 1ST AVE SW
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36265-3329
Mailing Address - Country:US
Mailing Address - Phone:256-435-2895
Mailing Address - Fax:256-435-2969
Practice Address - Street 1:1460 1ST AVE SW
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AL
Practice Address - Zip Code:36265-3329
Practice Address - Country:US
Practice Address - Phone:256-435-2895
Practice Address - Fax:256-435-2969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15032174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA15032OtherLICENSE NUMBER