Provider Demographics
NPI:1982638557
Name:BROWN, CHARLES ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:ANDREW
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:35 COLLIER RD NW
Mailing Address - Street 2:SUITE 775
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1613
Mailing Address - Country:US
Mailing Address - Phone:404-350-1122
Mailing Address - Fax:404-609-7608
Practice Address - Street 1:35 COLLIER RD NW
Practice Address - Street 2:SUITE 775
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1613
Practice Address - Country:US
Practice Address - Phone:404-350-1122
Practice Address - Fax:404-609-7608
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA067278207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1432769Medicaid
MSRR 110165099OtherRAILROAD
MS110000938Medicare ID - Type Unspecified
MS512I110031Medicare PIN
MSG51378Medicare UPIN
MS00118216Medicaid
MSP00669658Medicare PIN