1821106733 NPI number — MS. HOLLY LYNNE BROWN NP

Table of content: (NPI 1912374653)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821106733 NPI number — MS. HOLLY LYNNE BROWN NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN
Provider First Name:
HOLLY
Provider Middle Name:
LYNNE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821106733
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2279 BRIGHT WATER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SNELLVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30078-7373
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-315-9614
Provider Business Mailing Address Fax Number:
770-982-3514

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
925 GARRETT ST SE
Provider Second Line Business Practice Location Address:
SUITE 313
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30316-6826
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-323-1807
Provider Business Practice Location Address Fax Number:
866-885-6381
Provider Enumeration Date:
08/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LG0600X , with the licence number:  RN 151417 NP , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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