Provider Demographics
NPI:1972509420
Name:BROWN, ANDREA B (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:B
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 1:1821 MOUNT ZION RD
Mailing Address - Street 2:
Mailing Address - City:MORROW
Mailing Address - State:GA
Mailing Address - Zip Code:30260-3015
Mailing Address - Country:US
Mailing Address - Phone:470-754-6380
Mailing Address - Fax:877-874-7522
Practice Address - Street 1:5040 BILL GARDNER PKWY STE 310
Practice Address - Street 2:
Practice Address - City:LOCUST GROVE
Practice Address - State:GA
Practice Address - Zip Code:30248-3605
Practice Address - Country:US
Practice Address - Phone:770-898-4339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA022559207Q00000X
GA052321207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG290995196OtherMEDICARE
5F809OtherGROUP PTAN
LA1490474Medicaid
372594YNB7OtherPTAN