Individual provider Active NPI

Kenneth David Brown, PA-C

  • Physician Assistant
  • Rome, GA
National Provider Identifier
1326104092
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
001878 Issued in GA
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

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
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

LicenseStateTypeSpecialty
001878GAMDVision Therapy Optometrist

Practice roles

OrganizationSpecialtyStatusNew 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.

Verify at the official NPI Registry.