Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | SCDHEC MW003 | SC |
NPI | 1114130663 |
---|---|
Provider Name | Tavish Brinton |
First Address | Leesville, SC 29070-9670 |
Second Address | Leesville, SC 29070-9670 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2007 |
Last Update Date | 08/09/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
LM0004 | (05) | SC |