Provider Demographics
NPI:1730398884
Name:BROWN, CHADWICK JASON
Entity type:Individual
Prefix:MR
First Name:CHADWICK
Middle Name:JASON
Last Name:BROWN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 302
Mailing Address - Street 2:
Mailing Address - City:RHINE
Mailing Address - State:GA
Mailing Address - Zip Code:31077-0302
Mailing Address - Country:US
Mailing Address - Phone:229-385-1875
Mailing Address - Fax:229-424-0339
Practice Address - Street 1:162 OCILLA HWY
Practice Address - Street 2:BUILDING C
Practice Address - City:FITZGERALD
Practice Address - State:GA
Practice Address - Zip Code:31750-3744
Practice Address - Country:US
Practice Address - Phone:229-423-2039
Practice Address - Fax:229-424-0339
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH018308183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist