Provider Demographics
NPI:1649604943
Name:BROWN, EDDIE LORENZO SR (DRIVER)
Entity type:Individual
Prefix:MR
First Name:EDDIE
Middle Name:LORENZO
Last Name:BROWN
Suffix:SR
Gender:M
Credentials:DRIVER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 DEAN DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-3981
Mailing Address - Country:US
Mailing Address - Phone:931-278-7408
Mailing Address - Fax:931-906-9477
Practice Address - Street 1:127 DEAN DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-3981
Practice Address - Country:US
Practice Address - Phone:931-278-7408
Practice Address - Fax:931-906-9477
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-22
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3051494Medicaid
TN3726341Medicare UPIN