Healthcare Provider Details

I. General information

NPI: 1669804647
Provider Name (Legal Business Name): ELMER GERALD BROWN JR. FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2013
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 MONTGOMERY DR
ANDERSON SC
29621-3334
US

IV. Provider business mailing address

108 MONTGOMERY DR
ANDERSON SC
29621-3334
US

V. Phone/Fax

Practice location:
  • Phone: 864-225-5597
  • Fax: 864-516-8984
Mailing address:
  • Phone: 864-561-2888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number18339
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number18339
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: