Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0214X | Pediatric Pulmonologist | 054649 | GA |
NPI | 1043234313 |
---|---|
Provider Name | Randall W Brown |
First Address | Atlanta, GA 30342 |
Second Address | Atlanta, GA 30342 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 25/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
929675850 | (05) | GA |
D87924 | (02) |