Provider Demographics
NPI:1417063678
Name:BROWN, BEVERLY THERESE (MD)
Entity Type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:THERESE
Last Name:BROWN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11800 NORTHFALL LN STE 1405
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-7976
Mailing Address - Country:US
Mailing Address - Phone:678-551-5615
Mailing Address - Fax:770-559-9554
Practice Address - Street 1:11800 NORTHFALL LN STE 1405
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009
Practice Address - Country:US
Practice Address - Phone:678-551-5615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2018-06-22
Deactivation Date:2018-03-23
Deactivation Code:
Reactivation Date:2018-06-22
Provider Licenses
StateLicense IDTaxonomies
GA0425342083P0901X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A51186Medicare UPIN