Ethan Brown
Individual provider Active NPI Student in an Organized Health Care Education/Training Program · Sugar Valley, GA
NPI 1386562049 · NPPES record last updated Jul 8, 2026
Key facts
- NPI
- 1386562049
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Student in an Organized Health Care Education/Training Program 390200000X
- Practice address
- 136 Bayview LN NW
Sugar Valley, GA 30746-5106 - Phone
- (404) 791-2573
- NPI assigned
- Jul 8, 2026
- 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)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Yes |
Addresses
Primary practice location
136 Bayview LN NW
Sugar Valley, GA 30746-5106
Mailing address
136 Bayview LN NW
Sugar Valley, GA 30746-5106
Phone (404) 791-2573
Other providers in Sugar Valley, GA
All providers in Sugar Valley, GA · Student in an Organized Health Care Education/Training Program in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2026. 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.