Provider Demographics
NPI:1396873311
Name:BROWN, DAVID GORDON JR (MED)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:GORDON
Last Name:BROWN
Suffix:JR
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3219 LANDMARK ST STE 7A
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-7688
Mailing Address - Country:US
Mailing Address - Phone:252-355-2801
Mailing Address - Fax:252-355-4708
Practice Address - Street 1:3219 LANDMARK ST STE 7A
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-7688
Practice Address - Country:US
Practice Address - Phone:252-355-2801
Practice Address - Fax:252-355-4708
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2253101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC134AFOtherBCBS
NC184637OtherMEDCOST
NC6103090Medicaid