Individual
CLINTON JEFFERY BROWN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AA
Contact information
Practice address
901 18TH ST E, TIFTON, GA 31794-3648
(229) 353-6208
(229) 353-7722
Mailing address
901 18TH ST E, TIFTON, GA 31794-3648
(229) 353-6208
(229) 353-7722
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
002847
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002847
LICENSE NUMBER
GA
05
—
100000463B
—
GA
Enumeration date
11/09/2006
Last updated
07/18/2012
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