Provider Demographics
NPI:1801068754
Name:J. RENA OWSLEY-BROWN
Entity type:Organization
Organization Name:J. RENA OWSLEY-BROWN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:J.
Authorized Official - Middle Name:RENA
Authorized Official - Last Name:OWSLEY-BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-461-5500
Mailing Address - Street 1:1275 HIGHWAY 54 W
Mailing Address - Street 2:SUITE 204
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-4549
Mailing Address - Country:US
Mailing Address - Phone:770-461-5500
Mailing Address - Fax:770-461-1033
Practice Address - Street 1:1275 HIGHWAY 54 W
Practice Address - Street 2:SUITE 204
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-4549
Practice Address - Country:US
Practice Address - Phone:770-461-5500
Practice Address - Fax:770-461-1033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADNO128931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA110289OtherDORAL