Provider Demographics
NPI:1750376323
Name:EISENBROWN, JEANNE NICOLE (MD)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:NICOLE
Last Name:EISENBROWN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 S 8TH ST STE 304
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-4260
Mailing Address - Country:US
Mailing Address - Phone:706-242-5201
Mailing Address - Fax:706-242-5204
Practice Address - Street 1:619 S 8TH ST STE 304
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-4260
Practice Address - Country:US
Practice Address - Phone:706-242-5201
Practice Address - Fax:706-242-5204
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84013208800000X
GA97508208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264546700Medicaid
FL157012Medicare ID - Type Unspecified
FL264546700Medicaid