Provider Demographics
NPI:1639309065
Name:BROWN FAMILY MEDICINE, LLC
Entity Type:Organization
Organization Name:BROWN FAMILY MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:CUZZORT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-290-8115
Mailing Address - Street 1:20 RIVERBEND DR SW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-6066
Mailing Address - Country:US
Mailing Address - Phone:706-291-1270
Mailing Address - Fax:706-291-1276
Practice Address - Street 1:20 RIVERBEND DR SW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161-6066
Practice Address - Country:US
Practice Address - Phone:706-291-1270
Practice Address - Fax:706-291-1276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-20
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA036109207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1588698054OtherIND NPI
GAF56983Medicare UPIN