Provider Demographics
NPI:1942331566
Name:BROWN, ALEATHA A (DO)
Entity Type:Individual
Prefix:DR
First Name:ALEATHA
Middle Name:A
Last Name:BROWN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:ANGEL
Other - Middle Name:ALEATHA
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 751803
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1803
Mailing Address - Country:US
Mailing Address - Phone:336-993-8181
Mailing Address - Fax:
Practice Address - Street 1:291 BROAD ST
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-2932
Practice Address - Country:US
Practice Address - Phone:336-993-8181
Practice Address - Fax:336-996-9539
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH8867207Q00000X
NC2010-01050207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5916107Medicaid
NC2403243Medicare PIN