Provider Demographics
NPI:1679613871
Name:BROWN, ALIA SAMPSON (MD)
Entity Type:Individual
Prefix:DR
First Name:ALIA
Middle Name:SAMPSON
Last Name:BROWN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ALIA
Other - Middle Name:JANINE
Other - Last Name:SAMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2383 PATE STREET
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-3250
Mailing Address - Country:US
Mailing Address - Phone:770-972-4845
Mailing Address - Fax:770-972-0358
Practice Address - Street 1:2383 PATE STREET
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-3250
Practice Address - Country:US
Practice Address - Phone:770-972-4845
Practice Address - Fax:770-972-0358
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYIP975207N00000X
GA64786207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I070182Medicare PIN