Provider Demographics
NPI:1720797236
Name:BROWN, WESLEY W (MPT)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:W
Last Name:BROWN
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1233 E JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-4748
Mailing Address - Country:US
Mailing Address - Phone:229-236-8989
Mailing Address - Fax:
Practice Address - Street 1:1233 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-4748
Practice Address - Country:US
Practice Address - Phone:229-236-8989
Practice Address - Fax:229-236-8990
Is Sole Proprietor?:No
Enumeration Date:2022-11-23
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT016369208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation