Provider Demographics
NPI:1326089475
Name:BROWN, KIRK TAHAMA (MD)
Entity Type:Individual
Prefix:DR
First Name:KIRK
Middle Name:TAHAMA
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3779 MIDVALE RD
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-3237
Mailing Address - Country:US
Mailing Address - Phone:770-491-7329
Mailing Address - Fax:770-491-0071
Practice Address - Street 1:898 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:GA
Practice Address - Zip Code:31064-1261
Practice Address - Country:US
Practice Address - Phone:800-291-4020
Practice Address - Fax:919-419-7247
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA035388207P00000X
GA35388207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine