Provider Demographics
NPI:1487944617
Name:BROWN, COREY NATHANIEL (DO)
Entity type:Individual
Prefix:DR
First Name:COREY
Middle Name:NATHANIEL
Last Name:BROWN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 599
Mailing Address - Street 2:
Mailing Address - City:FLORA
Mailing Address - State:MS
Mailing Address - Zip Code:39071-0599
Mailing Address - Country:US
Mailing Address - Phone:662-545-7300
Mailing Address - Fax:
Practice Address - Street 1:350 CROSSGATES BLVD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39042-2601
Practice Address - Country:US
Practice Address - Phone:662-545-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-08
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADO-06316207R00000X
ND19522207R00000X
AZ010240207R00000X
COCDR.0002502207R00000X
LA334790207R00000X
GA94554207R00000X
CA20A11568207R00000X
TXU1584207R00000X
VT162.0000141207R00000X
WI2707-321207R00000X
MS22375207R00000X
MDH0096600207R00000X
OH34C.000075207R00000X
ARE-7796207R00000X
TN2930207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine