Provider Demographics
NPI:1255392346
Name:BROWN, TIMOTHY BONITTO (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:BONITTO
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:83 UPPER RIVERDALE ROAD
Mailing Address - Street 2:SUITE 135
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274
Mailing Address - Country:US
Mailing Address - Phone:770-991-0778
Mailing Address - Fax:770-991-7390
Practice Address - Street 1:83 UPPER RIVERDALE ROAD
Practice Address - Street 2:SUITE 135
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274
Practice Address - Country:US
Practice Address - Phone:770-991-0778
Practice Address - Fax:770-991-7390
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA032110207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAE83158OtherCOVENTRY HEALTH INSURANCE
GA000416116LMedicaid
GA912295OtherBLUE CROSS BLUE SHIELD GA
GA912295OtherBLUE CROSS BLUE SHIELD GA