Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 20494 | SC |
NPI | 1003826504 |
---|---|
Provider Name | Pamela I Brown |
First Address | West Columbia, SC 29171-6069 |
Second Address | Columbia, SC 29212-1180 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2006 |
Last Update Date | 15/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
080193472 | MEDICARE RAILROAD (01) | SC |
204941 | (05) | SC |
H07000 | (02) | SC |