Provider Demographics
NPI:1386808954
Name:LUMIS C. BROWN DDS
Entity type:Organization
Organization Name:LUMIS C. BROWN DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LUMIS
Authorized Official - Middle Name:C
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:12/01/2009
Authorized Official - Phone:229-377-6125
Mailing Address - Street 1:240 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:CAIRO
Mailing Address - State:GA
Mailing Address - Zip Code:39828-1556
Mailing Address - Country:US
Mailing Address - Phone:229-377-6125
Mailing Address - Fax:229-377-5601
Practice Address - Street 1:240 S BROAD ST
Practice Address - Street 2:
Practice Address - City:CAIRO
Practice Address - State:GA
Practice Address - Zip Code:39828-1556
Practice Address - Country:US
Practice Address - Phone:229-377-6125
Practice Address - Fax:229-377-5601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA9404122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty