Provider Demographics
NPI:1174688121
Name:BROWN, JAMES LEWIS JR (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:LEWIS
Last Name:BROWN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 657
Mailing Address - Street 2:
Mailing Address - City:DEMOREST
Mailing Address - State:GA
Mailing Address - Zip Code:30535-0657
Mailing Address - Country:US
Mailing Address - Phone:706-839-4092
Mailing Address - Fax:706-839-1970
Practice Address - Street 1:800 AUSTIN DR
Practice Address - Street 2:
Practice Address - City:DEMOREST
Practice Address - State:GA
Practice Address - Zip Code:30535-4508
Practice Address - Country:US
Practice Address - Phone:706-839-4092
Practice Address - Fax:706-839-1970
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA021652207R00000X
GA21652261QP2300X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG15451AOtherMEDICARE PTAN