Provider Demographics
NPI:1366997637
Name:BROWN FAMILY PRACTICE, INC.
Entity type:Organization
Organization Name:BROWN FAMILY PRACTICE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:423-626-0277
Mailing Address - Street 1:1582 N BROAD ST STE 2
Mailing Address - Street 2:
Mailing Address - City:TAZEWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37879-4352
Mailing Address - Country:US
Mailing Address - Phone:423-626-0277
Mailing Address - Fax:423-626-0082
Practice Address - Street 1:1582 N BROAD ST
Practice Address - Street 2:SUITE 2
Practice Address - City:TAZEWELL
Practice Address - State:TN
Practice Address - Zip Code:37879-4352
Practice Address - Country:US
Practice Address - Phone:423-626-0277
Practice Address - Fax:423-626-0082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-16
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN14103261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNAPN 14103OtherAPN LICENSE