Provider Demographics
NPI:1932128840
Name:BROWN, CYNTHIA W (MD)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:W
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 1:100 WILLOWBROOK WAY SE
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30701-1404
Mailing Address - Country:US
Mailing Address - Phone:706-529-3025
Mailing Address - Fax:706-383-6578
Practice Address - Street 1:215 CURTIS PARKWAY NE
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-1404
Practice Address - Country:US
Practice Address - Phone:706-529-3025
Practice Address - Fax:706-383-6578
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA049876207R00000X, 208000000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000920609AMedicaid
GA11BDTKRMedicare ID - Type Unspecified
GAH42283Medicare UPIN