Provider Demographics
NPI:1609009174
Name:BROWN, TAMU TAYARI (MD)
Entity Type:Individual
Prefix:
First Name:TAMU
Middle Name:TAYARI
Last Name:BROWN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1265 UPPER HEMBREE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-1257
Mailing Address - Country:US
Mailing Address - Phone:770-751-1433
Mailing Address - Fax:770-751-7410
Practice Address - Street 1:1265 UPPER HEMBREE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-1257
Practice Address - Country:US
Practice Address - Phone:770-751-1433
Practice Address - Fax:770-751-7410
Is Sole Proprietor?:No
Enumeration Date:2009-08-31
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA068379207N00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003130142AMedicaid
GA202I077909Medicare PIN