Provider Demographics
NPI:1861672990
Name:BROWN, BILLY JAMES (PA)
Entity Type:Individual
Prefix:
First Name:BILLY
Middle Name:JAMES
Last Name:BROWN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:800 OHIO AVE
Mailing Address - Street 2:
Mailing Address - City:CLARKSDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38614-7200
Mailing Address - Country:US
Mailing Address - Phone:662-624-4292
Mailing Address - Fax:662-624-4354
Practice Address - Street 1:510 HIGHWAY 322
Practice Address - Street 2:
Practice Address - City:CLARKSDALE
Practice Address - State:MS
Practice Address - Zip Code:38614-4717
Practice Address - Country:US
Practice Address - Phone:662-624-4292
Practice Address - Fax:662-624-4354
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601002463363AM0700X
MSPA00206363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical