Provider Demographics
NPI:1972543932
Name:BROWN, EMILY M (OD)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:M
Last Name:BROWN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:M
Other - Last Name:WALCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:127 E GENERAL SCREVEN WAY
Mailing Address - Street 2:
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313-3013
Mailing Address - Country:US
Mailing Address - Phone:912-877-2422
Mailing Address - Fax:912-877-2430
Practice Address - Street 1:127 E GENERAL SCREVEN WAY
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-3013
Practice Address - Country:US
Practice Address - Phone:912-877-2422
Practice Address - Fax:912-877-2430
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002844152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP00181423OtherRAILROAD MEDICARE
SCD13340Medicaid
SCV01328Medicare UPIN
SCP00181423OtherRAILROAD MEDICARE