Provider Demographics
NPI:1851170146
Name:BROWN, BENJAMIN DEAN
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:DEAN
Last Name:BROWN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2106 GABLES DR NE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-4181
Mailing Address - Country:US
Mailing Address - Phone:385-444-6106
Mailing Address - Fax:
Practice Address - Street 1:2106 GABLES DR NE
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30319-4181
Practice Address - Country:US
Practice Address - Phone:385-444-6106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant