Provider Demographics
NPI:1912046582
Name:BROWN, JOHN W JR (DMD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:BROWN
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1980 ADAMS RD
Mailing Address - Street 2:
Mailing Address - City:THE ROCK
Mailing Address - State:GA
Mailing Address - Zip Code:30285-2100
Mailing Address - Country:US
Mailing Address - Phone:770-567-8175
Mailing Address - Fax:770-567-8175
Practice Address - Street 1:316 W MAIN ST
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:GA
Practice Address - Zip Code:30286-3558
Practice Address - Country:US
Practice Address - Phone:706-647-5575
Practice Address - Fax:706-647-1935
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0103911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice