Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | RN210712 | GA |
NPI | 1003352204 |
---|---|
Provider Name | Briana Brown |
First Address | Warner Robins, GA 31088-1174 |
Second Address | Perry, GA 31069-2905 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2017 |
Last Update Date | 27/12/2019 |