Provider Demographics
NPI:1043565385
Name:BROWN, MACK ALLEN (CRNA)
Entity type:Individual
Prefix:
First Name:MACK
Middle Name:ALLEN
Last Name:BROWN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:150 JEFFERSON DAVIS BLVD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-5107
Mailing Address - Country:US
Mailing Address - Phone:601-445-1736
Mailing Address - Fax:601-445-1753
Practice Address - Street 1:129 JEFFERSON DAVIS BLVD
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-5103
Practice Address - Country:US
Practice Address - Phone:601-445-6200
Practice Address - Fax:601-445-6233
Is Sole Proprietor?:No
Enumeration Date:2012-07-23
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MSR884141367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered