Provider Demographics
NPI:1023098167
Name:BROWN, BRIAN G
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:G
Last Name:BROWN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:384D CARRIAGE HOUSE DRIVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-2268
Mailing Address - Country:US
Mailing Address - Phone:731-256-2006
Mailing Address - Fax:731-256-2007
Practice Address - Street 1:384D CARRIAGE HOUSE DRIVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2268
Practice Address - Country:US
Practice Address - Phone:731-256-2006
Practice Address - Fax:731-256-2007
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000108574163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3901457OtherMEDICARE SYMED
TN3901452Medicaid
TN3901456Medicaid
TN3901456Medicaid
TNS64113Medicare UPIN
TN3901456Medicare PIN