Provider Demographics
NPI:1730405754
Name:BROWN, BRANDON (MD)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1635 GUNBARREL ROAD
Mailing Address - Street 2:SUITE #400
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421
Mailing Address - Country:US
Mailing Address - Phone:423-778-5693
Mailing Address - Fax:423-778-3029
Practice Address - Street 1:1635 GUNBARREL ROAD
Practice Address - Street 2:SUITE 400
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421
Practice Address - Country:US
Practice Address - Phone:423-778-5693
Practice Address - Fax:423-778-3029
Is Sole Proprietor?:No
Enumeration Date:2010-04-15
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN58372207N00000X
FLME122644207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN58372OtherSTATE OF TENNESSEE MEDICAL LICENSE
FL014416800Medicaid