Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 28193 | SC |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 62824 | GA |
NPI | 1346371614 |
---|---|
Provider Name | Candace Denise Brown |
First Address | Colorado Springs, CO 80907-6819 |
Second Address | Atlanta, GA 30329 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2007 |
Last Update Date | 01/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
23938P001 | (02) | GA |