Roland Manoutcheher Brown, M.D.
Individual provider Active NPI General Practice Physician · Moultrie, GA
NPI 1295818581 · NPPES record last updated Oct 4, 2019
Key facts
- NPI
- 1295818581
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Physician 208D00000X
- License
- O43008 (GA)
- Practice address
- 2801 S Main St
Moultrie, GA 31768-6908 - Phone
- (229) 891-2170
- Fax
- (229) 890-3606
- NPI assigned
- Oct 23, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| O43008 | GA | MD | General Practice Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician |
208D00000X | O43008 | GA | Yes |
Addresses
Primary practice location
2801 S Main St
Moultrie, GA 31768-6908
Mailing address
2801 S Main St
Moultrie, GA 31768-6908
Phone (229) 891-2170
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 85001900G | Medicaid | GA |
Other providers in Moultrie, GA
- Catherine Ann Coomer Brown
- Christopher Allen Brown
- Karlie Brown
- Michael Brown
- Robert Moore Brown
- Building Blocks Therapy LLC
- Kimberly Dawn Burton
- Alberta Daniels Butler
- C. Yvonne Cox, PH.D.
- Glinda Marie Cannon
All providers in Moultrie, GA · General Practice Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 4, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.