Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | 62478 | GA |
Y | 207RP1001X | Pulmonary Disease | 238219 | NY |
NPI | 1063680882 |
---|---|
Provider Name | Dr. Craig Mitchell Brown |
First Address | Gainesville, GA 30501-3862 |
Second Address | Gainesville, GA 30501-3862 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2008 |
Last Update Date | 14/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11628634 | CAQH (01) |