Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | RN190606 | GA |
NPI | 1003207028 |
---|---|
Provider Name | Charles Brown |
First Address | Rome, GA 30161-3209 |
Second Address | Rome, GA 30165-5621 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2015 |
Last Update Date | 12/02/2015 |