Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 37766 | GA |
NPI | 1245239698 |
---|---|
Provider Name | Dr. Stanley Joe Brown |
First Address | Sandy Springs, GA 30328-5512 |
Second Address | Sandy Springs, GA 30328-5512 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2005 |
Last Update Date | 05/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F45697 | (02) |