Healthcare Provider Details

I. General information

NPI: 1942293857
Provider Name (Legal Business Name): BEULAH M. BROOKS DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 12/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

172 SPRING ST
CHARLESTON SC
29403-5220
US

IV. Provider business mailing address

PO BOX 1633
WALTERBORO SC
29488-0016
US

V. Phone/Fax

Practice location:
  • Phone: 843-722-8628
  • Fax: 843-722-1055
Mailing address:
  • Phone: 843-549-6271
  • Fax: 843-542-9030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number123
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: