Provider Demographics
NPI:1730941063
Name:BROWN, GEORGE THOMAS III (DMD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:THOMAS
Last Name:BROWN
Suffix:III
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 HIGHWAY 54 W STE 204
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-4538
Mailing Address - Country:US
Mailing Address - Phone:770-461-5500
Mailing Address - Fax:770-461-1033
Practice Address - Street 1:1275 HIGHWAY 54 W STE 204
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-4538
Practice Address - Country:US
Practice Address - Phone:770-461-5500
Practice Address - Fax:770-461-1033
Is Sole Proprietor?:No
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN1233051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice