Provider Demographics
NPI:1073020400
Name:BROWN, TOMMY LEE JR (PA)
Entity type:Individual
Prefix:
First Name:TOMMY
Middle Name:LEE
Last Name:BROWN
Suffix:JR
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6600 VAN AALST BLVD
Mailing Address - Street 2:MARTIN ARMY COMMUNITY HOSPITAL
Mailing Address - City:FORT MOORE
Mailing Address - State:GA
Mailing Address - Zip Code:31905
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6600 VAN AALST BLVD
Practice Address - Street 2:MARTIN ARMY COMMUNITY HOSPITAL
Practice Address - City:FORT BENNING
Practice Address - State:GA
Practice Address - Zip Code:31905
Practice Address - Country:US
Practice Address - Phone:808-295-4601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-08
Last Update Date:2025-04-30
Deactivation Date:2021-05-25
Deactivation Code:
Reactivation Date:2021-06-18
Provider Licenses
StateLicense IDTaxonomies
GAM5024678146L00000X
2255A2300X
GA1198850363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer