Provider Demographics
NPI:1932429024
Name:DR BROWN N EKELEDO LLC
Entity Type:Organization
Organization Name:DR BROWN N EKELEDO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BROWN
Authorized Official - Middle Name:N
Authorized Official - Last Name:EKELEDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-746-2719
Mailing Address - Street 1:770 PINE ST
Mailing Address - Street 2:SUITE 550
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-2173
Mailing Address - Country:US
Mailing Address - Phone:478-746-2719
Mailing Address - Fax:478-746-4808
Practice Address - Street 1:770 PINE ST
Practice Address - Street 2:SUITE 550
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-2173
Practice Address - Country:US
Practice Address - Phone:478-746-2719
Practice Address - Fax:478-746-4808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-11
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA025151208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000268232BMedicaid
GA000268232BMedicaid
GAC01817Medicare UPIN