Provider Demographics
NPI:1922162825
Name:BROWN, JAMES G (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:G
Last Name:BROWN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14641
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317-4641
Mailing Address - Country:US
Mailing Address - Phone:850-309-0811
Mailing Address - Fax:850-309-0812
Practice Address - Street 1:1927 BUFORD BLVD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4466
Practice Address - Country:US
Practice Address - Phone:850-309-0811
Practice Address - Fax:850-309-0812
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY3424103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL75533AMedicare ID - Type Unspecified