Provider Demographics
NPI:1639118128
Name:BROWN, PHILLIP R (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:R
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1199 PRINCE AVE
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2797
Mailing Address - Country:US
Mailing Address - Phone:706-475-7000
Mailing Address - Fax:770-307-4812
Practice Address - Street 1:314 N BROAD ST
Practice Address - Street 2:350
Practice Address - City:WINDER
Practice Address - State:GA
Practice Address - Zip Code:30680
Practice Address - Country:US
Practice Address - Phone:770-307-4762
Practice Address - Fax:770-307-4812
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA042797208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000749592OMedicaid
GA6073153OtherCIGNA
GA52596602OtherBCBS
GA000749592BMedicaid
GA52596602OtherBCBS
GAG54447Medicare UPIN
GA20202I3410Medicare PIN