Provider Demographics
NPI:1508091844
Name:BROWN, THOMAS D JR (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:D
Last Name:BROWN
Suffix:JR
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 1:826 HOLLY DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-2110
Mailing Address - Country:US
Mailing Address - Phone:770-534-9535
Mailing Address - Fax:
Practice Address - Street 1:826 HOLLY DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-2110
Practice Address - Country:US
Practice Address - Phone:770-534-9535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-15
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA009777207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00008225AMedicaid
GA04BDBWZMedicare PIN