Basic Information
| Provider Information | |||||||||
| NPI: | 1003027434 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | RENEE | ||||||||
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| Credential: | N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | MERCER MEDICINE CREDENTIALING | ||||||||
| Address2: | 1327 STADIUM DRIVE | ||||||||
| City: | MACON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 312071302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4783012362 | ||||||||
| FaxNumber: | 4783012391 | ||||||||
| Practice Location | |||||||||
| Address1: | 655 1ST ST | ||||||||
| Address2: | |||||||||
| City: | MACON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 312012852 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4783015930 | ||||||||
| FaxNumber: | 4783015932 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2007 | ||||||||
| LastUpdateDate: | 10/29/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 067038 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.