Provider Demographics
NPI:1104343839
Name:BROWN, PANDORA G (CERTIFIED HAIR LOSS)
Entity type:Individual
Prefix:MRS
First Name:PANDORA
Middle Name:G
Last Name:BROWN
Suffix:
Gender:F
Credentials:CERTIFIED HAIR LOSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:65 BLACK WATCH CT
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30215-8047
Mailing Address - Country:US
Mailing Address - Phone:404-788-8364
Mailing Address - Fax:770-703-8736
Practice Address - Street 1:65 BLACK WATCH CT
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30215
Practice Address - Country:US
Practice Address - Phone:404-788-8364
Practice Address - Fax:770-703-8736
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty