Provider Demographics
NPI:1790709434
Name:BROWN, JANET OWEN (AA-C)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:OWEN
Last Name:BROWN
Suffix:
Gender:F
Credentials:AA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 HARDY ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-3260
Mailing Address - Country:US
Mailing Address - Phone:770-815-0206
Mailing Address - Fax:
Practice Address - Street 1:2620 SATELLITE BLVD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-1290
Practice Address - Country:US
Practice Address - Phone:404-785-8000
Practice Address - Fax:404-785-8001
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA01801367H00000X
GA001801367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA100001417AMedicaid
GA97BBFWCMedicare ID - Type Unspecified