Provider Demographics
NPI:1366553869
Name:BROWN, RONALD R (PH D)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:R
Last Name:BROWN
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 S PETERS RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-5207
Mailing Address - Country:US
Mailing Address - Phone:865-238-5901
Mailing Address - Fax:865-238-5909
Practice Address - Street 1:224 S PETERS RD
Practice Address - Street 2:SUITE110
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-5207
Practice Address - Country:US
Practice Address - Phone:865-238-5901
Practice Address - Fax:865-238-5909
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP0699103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3684560Medicaid
TN3684560Medicare ID - Type Unspecified