Provider Demographics
NPI:1275617888
Name:BREWSTER, JEFFREY LYNN (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:LYNN
Last Name:BREWSTER
Suffix:
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 1:282 SERENITY LOOP
Mailing Address - Street 2:
Mailing Address - City:CATAULA
Mailing Address - State:GA
Mailing Address - Zip Code:31804-2367
Mailing Address - Country:US
Mailing Address - Phone:762-207-9041
Mailing Address - Fax:
Practice Address - Street 1:282 SERENITY LOOP
Practice Address - Street 2:
Practice Address - City:CATAULA
Practice Address - State:GA
Practice Address - Zip Code:31804-2367
Practice Address - Country:US
Practice Address - Phone:762-207-9041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA052896208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA977818814CMedicaid
GA977818814AMedicaid
GA977818814BMedicaid
GA977818814DMedicaid