Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 2007-00209 | NC |
N | 111NI0900X | Internist | 2007-00209 | NC |
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 064515 | GA |
NPI | 1073631735 |
---|---|
Provider Name | Dr. Kevin Desean Brown |
First Address | Suwanee, GA 30024-9119 |
Second Address | Suwanee, GA 30024-9119 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2007 |
Last Update Date | 28/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5900015 | (05) | NC |