Provider Demographics
NPI:1265774632
Name:BROWN, MURRAY FRED (DMD)
Entity type:Individual
Prefix:DR
First Name:MURRAY
Middle Name:FRED
Last Name:BROWN
Suffix:
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 1:1618 MEADOWS LN
Mailing Address - Street 2:PO BOX 363
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30474-8914
Mailing Address - Country:US
Mailing Address - Phone:912-537-2238
Mailing Address - Fax:
Practice Address - Street 1:1618 MEADOWS LN
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-8914
Practice Address - Country:US
Practice Address - Phone:912-537-2238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-22
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN008330122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist