Provider Demographics
NPI:1376602532
Name:TAMARA BROWN, MD, LLC
Entity Type:Organization
Organization Name:TAMARA BROWN, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:YVETTE
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-696-4141
Mailing Address - Street 1:PO BOX 310539
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31131-0539
Mailing Address - Country:US
Mailing Address - Phone:404-696-4141
Mailing Address - Fax:404-696-4166
Practice Address - Street 1:5835 CAMPBELLTON ROAD SW
Practice Address - Street 2:SUITE 201
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-8014
Practice Address - Country:US
Practice Address - Phone:404-696-4141
Practice Address - Fax:404-696-4166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA040620207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DD6207OtherRAILROAD MEDICARE
DD6207OtherRAILROAD MEDICARE
=========OtherUNITED HEALTHCARE
GA=========OtherBLUE CROSS/ BLUE SHIELD
=========OtherCIGNA
GA=========OtherAETNA
GA=========OtherBLUE CROSS/ BLUE SHIELD