Provider Demographics
NPI:1760514640
Name:BROWN, JINA RYU (MD)
Entity Type:Individual
Prefix:
First Name:JINA
Middle Name:RYU
Last Name:BROWN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11050 CRABAPPLE ROAD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075
Mailing Address - Country:US
Mailing Address - Phone:770-518-9277
Mailing Address - Fax:770-518-8718
Practice Address - Street 1:11050 CRABAPPLE ROAD
Practice Address - Street 2:SUITE 120
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075
Practice Address - Country:US
Practice Address - Phone:770-518-9277
Practice Address - Fax:770-518-8718
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA056522208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
F59819Medicare UPIN