Basic Information
| Provider Information | |||||||||
| NPI: | 1194727651 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BREWER | ||||||||
| FirstName: | DOUGLAS | ||||||||
| MiddleName: | ALAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 1ST ST STE 240 | ||||||||
| Address2: | |||||||||
| City: | MACON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 312018308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4786336900 | ||||||||
| FaxNumber: | 4786332175 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 1ST ST | ||||||||
| Address2: | |||||||||
| City: | MACON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 312018300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4786336900 | ||||||||
| FaxNumber: | 4786332175 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2005 | ||||||||
| LastUpdateDate: | 09/16/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 04/10/2006 | ||||||||
| NPIReactivationDate: | 04/10/2006 | ||||||||
| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208C00000X | 038696 | GA | Y | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery |
No ID Information.