Provider Demographics
NPI:1861408296
Name:BROWN, JERRY L (DO)
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:L
Last Name:BROWN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:4163 QUAIL SPRINGS CIR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907-2102
Mailing Address - Country:US
Mailing Address - Phone:706-860-9640
Mailing Address - Fax:
Practice Address - Street 1:1 FREEDOM WAY # 222
Practice Address - Street 2:VAMC AUGUSTA
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-6258
Practice Address - Country:US
Practice Address - Phone:706-823-2227
Practice Address - Fax:706-823-1752
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA31389207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology