Provider Demographics
NPI:1699408948
Name:BROWN, AUSTIN NICHOLAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:NICHOLAS
Last Name:BROWN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 CHINQUAPIN DR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31523-7059
Mailing Address - Country:US
Mailing Address - Phone:770-295-8384
Mailing Address - Fax:
Practice Address - Street 1:288 REDFERN VLG
Practice Address - Street 2:
Practice Address - City:ST SIMONS ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31522-2536
Practice Address - Country:US
Practice Address - Phone:912-638-9090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN1227531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice