Provider Demographics
NPI:1205829009
Name:BROWN, KIMBERLY S (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:S
Last Name:BROWN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2622 MEREDYTH DR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-0206
Mailing Address - Country:US
Mailing Address - Phone:229-432-9515
Mailing Address - Fax:229-888-9520
Practice Address - Street 1:2622 MEREDYTH DR
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-0206
Practice Address - Country:US
Practice Address - Phone:229-432-9515
Practice Address - Fax:229-888-9520
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2010-04-28
Deactivation Date:2006-03-27
Deactivation Code:
Reactivation Date:2006-04-12
Provider Licenses
StateLicense IDTaxonomies
GA045179207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00791744AMedicaid
GA13BDCXFMedicare ID - Type Unspecified
GAG00947Medicare UPIN