Provider Demographics
NPI:1154890564
Name:BROWN-CAGGIANO, SIDNEY ADELE (PA-C, MPAS)
Entity type:Individual
Prefix:
First Name:SIDNEY
Middle Name:ADELE
Last Name:BROWN-CAGGIANO
Suffix:
Gender:F
Credentials:PA-C, MPAS
Other - Prefix:
Other - First Name:SIDNEY
Other - Middle Name:BROWN
Other - Last Name:CAGGIANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:4645 TIMBER RIDGE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-7542
Mailing Address - Country:US
Mailing Address - Phone:706-223-1235
Mailing Address - Fax:706-568-2705
Practice Address - Street 1:4645 TIMBER RIDGE DR STE 100
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-7542
Practice Address - Country:US
Practice Address - Phone:706-223-1235
Practice Address - Fax:706-568-2705
Is Sole Proprietor?:No
Enumeration Date:2018-11-14
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA009055207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology