Provider Demographics
NPI:1326365156
Name:BROWN, RONALD II (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:BROWN
Suffix:II
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 1:820 SAINT SEBASTIAN WAY STE 2D
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-2636
Mailing Address - Country:US
Mailing Address - Phone:706-722-1461
Mailing Address - Fax:706-722-2767
Practice Address - Street 1:820 SAINT SEBASTIAN WAY STE 2D
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-2636
Practice Address - Country:US
Practice Address - Phone:706-722-1461
Practice Address - Fax:706-722-2767
Is Sole Proprietor?:No
Enumeration Date:2010-05-04
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME116030207R00000X
GA077970207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003134379CMedicaid