Provider Demographics
NPI:1790889178
Name:CLARK-BROWN, ANNETTE RENAE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNETTE
Middle Name:RENAE
Last Name:CLARK-BROWN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4500 STUART STREET
Mailing Address - Street 2:MONCRIEF ARMY COMMUNITY HOSPITAL FAMILY HEALTH CENTER
Mailing Address - City:FORT JACKSON
Mailing Address - State:SC
Mailing Address - Zip Code:29207-5000
Mailing Address - Country:US
Mailing Address - Phone:803-751-2553
Mailing Address - Fax:
Practice Address - Street 1:4500 STUART STREET
Practice Address - Street 2:USA MEDDAC
Practice Address - City:FORT JACKSON
Practice Address - State:SC
Practice Address - Zip Code:29207
Practice Address - Country:US
Practice Address - Phone:803-751-2234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC27523207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine