Provider Demographics
NPI:1124062831
Name:BROWN, RANDALL B (MD)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:B
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-2825
Mailing Address - Country:US
Mailing Address - Phone:478-743-9762
Mailing Address - Fax:478-746-6612
Practice Address - Street 1:575 1ST ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-2825
Practice Address - Country:US
Practice Address - Phone:478-743-9762
Practice Address - Fax:478-746-6612
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031884208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA770002580OtherRAILROAD
GA00638514BMedicaid
GA52484361OtherBLUE CROSS
GAF95981Medicare UPIN
GA33BDBFZMedicare ID - Type Unspecified