Provider Demographics
NPI:1528382009
Name:BROWN, DEANNA GARDENHIRE (MD)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:GARDENHIRE
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 1:2051 HAMILL RD
Mailing Address - Street 2:STE 301A
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-6614
Mailing Address - Country:US
Mailing Address - Phone:423-870-3376
Mailing Address - Fax:
Practice Address - Street 1:2051 HAMILL RD
Practice Address - Street 2:STE 301A
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-6614
Practice Address - Country:US
Practice Address - Phone:423-870-3376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-26
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TN51193207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program