Provider Demographics
NPI:1134246911
Name:BROWN, WILLIAM JR (PTA)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:
Last Name:BROWN
Suffix:JR
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:559 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:GROVETOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30813-3752
Mailing Address - Country:US
Mailing Address - Phone:706-651-8167
Mailing Address - Fax:
Practice Address - Street 1:3525 AUGUSTUS RD # 3188
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-2701
Practice Address - Country:US
Practice Address - Phone:803-642-8376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1471225200000X
GA1574225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant