Provider Demographics
NPI:1407968506
Name:SCOTT A. BROWN DDS PC
Entity Type:Organization
Organization Name:SCOTT A. BROWN DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-898-2066
Mailing Address - Street 1:2093 JONESBORO RD
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-5993
Mailing Address - Country:US
Mailing Address - Phone:770-898-2066
Mailing Address - Fax:770-898-8893
Practice Address - Street 1:2093 JONESBORO RD
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-5993
Practice Address - Country:US
Practice Address - Phone:770-898-2066
Practice Address - Fax:770-898-8893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA104761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00343967AMedicaid
GA00343967BMedicaid
GA0112281OtherBCBS OF TENNESSEE PROVIDE
GA611327OtherUNITED CONCORDIA PROVIDER