Provider Demographics
NPI:1467446286
Name:BROWN, DERONDA FELICIA (MD)
Entity type:Individual
Prefix:DR
First Name:DERONDA
Middle Name:FELICIA
Last Name:BROWN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DERONDA
Other - Middle Name:FELICIA
Other - Last Name:PERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:106 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31401-2917
Mailing Address - Country:US
Mailing Address - Phone:912-527-1097
Mailing Address - Fax:912-527-1126
Practice Address - Street 1:1604 RIVER OAKS DR
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-4587
Practice Address - Country:US
Practice Address - Phone:912-445-5183
Practice Address - Fax:912-445-5183
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA050079207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000908388BMedicaid
GA000908388CMedicaid
P00062865OtherRAILROAD MEDICARE
GAP00410293Medicare PIN
H37331Medicare UPIN
GA000908388CMedicaid
GA08CBBMRMedicare PIN