Basic Information
| Provider Information | |||||||||
| NPI: | 1336152743 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | WILLIAM | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2930 | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462062930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8444689496 | ||||||||
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| Practice Location | |||||||||
| Address1: | 975 E THIRD ST | ||||||||
| Address2: | |||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374032147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4236028400 | ||||||||
| FaxNumber: | 4236028401 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2006 | ||||||||
| LastUpdateDate: | 11/10/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | MD20336 | TN | Y | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 40327 | GA | N | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 050057216 | 01 | TN | MEDICARE RAILROAD | OTHER | 009801380 | 05 | AL | MEDICAID | 000518592B | 05 | GA | MEDICAID | 89067CP | 05 | NC | MEDICAID | N362754 | 01 | GA | WELLCARE(GA MEDICAID) | OTHER | 3074802 | 01 | TN | BLUE CROSS BLUE SHIELD TN | OTHER | Q002742 | 05 | TN | MEDICAID |