Provider Demographics
NPI:1912004441
Name:BROWN, SANNAGAIL ANDRIGUE (MD)
Entity Type:Individual
Prefix:MS
First Name:SANNAGAIL
Middle Name:ANDRIGUE
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 1:1123 RALPH DAVID ABERNATHY BLVD
Mailing Address - Street 2:
Mailing Address - City:ALTANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30310
Mailing Address - Country:US
Mailing Address - Phone:404-758-9300
Mailing Address - Fax:404-758-0798
Practice Address - Street 1:1123 RALPH DAVID ABERNATHY BLVD
Practice Address - Street 2:
Practice Address - City:ALTANTA
Practice Address - State:GA
Practice Address - Zip Code:30310
Practice Address - Country:US
Practice Address - Phone:404-758-9300
Practice Address - Fax:404-758-0798
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA36349207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00564682AMedicaid
08BDGBSMedicare ID - Type Unspecified
GA00564682AMedicaid