Active NPI
Kenneth David Brown, PA-C
- Physician Assistant
- Rome, GA
National Provider Identifier
1326104092
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 001878
- Practice address
- 504 Redmond Rd NW
Rome, GA 30165-1416 - Phone
- (706) 235-3855
- Fax
- (706) 290-2399
- NPI assigned
- Dec 28, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 001878 | GA | Primary |
Addresses
Primary practice location
504 Redmond Rd NW
Rome, GA 30165-1416
Mailing address
1825 Martha Berry Blvd NW
Rome, GA 30165-1625
Phone (706) 295-5331
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 001878 | GA | MD | Vision Therapy Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Harbin Clinic, LLC | Current | Accepting new patients |
Locations
1035 Red Bud Rd NE
Calhoun, GA 30701
Phone (706) 602-7800
1825 Martha Berry Blvd NW
Rome, GA 30165
Phone (706) 238-8073
504 Redmond Rd NW
Rome, GA 30165
Phone (706) 235-3855
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167264000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1326104092",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1825 MARTHA BERRY BLVD NW",
"city": "ROME",
"state": "GA",
"postal_code": "301651625",
"telephone_number": "706-295-5331"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "504 REDMOND RD NW",
"city": "ROME",
"state": "GA",
"postal_code": "301651416",
"telephone_number": "706-235-3855",
"fax_number": "706-290-2399"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROWN",
"first_name": "KENNETH",
"middle_name": "DAVID",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-28",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "GA",
"license": "001878",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Rome, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.