Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | RN271951 | GA |
N | 363LA2100X | Nurse Practitioner - Acute Care | RN271951 | GA |
NPI | 1003474867 |
---|---|
Provider Name | Mr. Joshua Elijah Brown |
First Address | Atlanta, GA 30326-3349 |
Second Address | Atlanta, GA 30331-2837 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2019 |
Last Update Date | 22/10/2019 |