Provider Demographics
NPI:1417072851
Name:BROWNLEE, SHAUN (MD)
Entity Type:Individual
Prefix:
First Name:SHAUN
Middle Name:
Last Name:BROWNLEE
Suffix:
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 1:559 HIGHLAND PARK AVE NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-1351
Mailing Address - Country:US
Mailing Address - Phone:404-577-9497
Mailing Address - Fax:
Practice Address - Street 1:4223 MORELAND AVE
Practice Address - Street 2:
Practice Address - City:CONLEY
Practice Address - State:GA
Practice Address - Zip Code:30288-2141
Practice Address - Country:US
Practice Address - Phone:404-366-2900
Practice Address - Fax:404-366-2994
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0430092083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511G700201Medicare PIN
GA202I080853Medicare UPIN
GA511I080118Medicare UPIN