Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 031884 | GA |
NPI | 1124062831 |
---|---|
Provider Name | Dr. Randall B Brown |
First Address | Macon, GA 31201-2825 |
Second Address | Macon, GA 31201-2825 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 12/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00638514B | (05) | GA |
52484361 | BLUE CROSS (01) | GA |
770002580 | RAILROAD (01) | GA |
F95981 | (02) | GA |