Provider Demographics
NPI:1235223710
Name:BROWN, MARGRET L (PA-C)
Entity Type:Individual
Prefix:
First Name:MARGRET
Middle Name:L
Last Name:BROWN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 JOHN MADDOX DR NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1413
Mailing Address - Country:US
Mailing Address - Phone:706-295-3992
Mailing Address - Fax:706-378-5585
Practice Address - Street 1:11 JOHN MADDOX DR NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1413
Practice Address - Country:US
Practice Address - Phone:706-295-3992
Practice Address - Fax:706-378-5585
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA9052363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP42621OtherUPIN
SCP42621Medicare UPIN
SC0412PAMedicaid