Healthcare Provider Details

I. General information

NPI: 1578312336
Provider Name (Legal Business Name): MADISON BRINDLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2024
Last Update Date: 05/15/2024
Certification Date: 05/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 BULL ST
COLUMBIA SC
29201-1708
US

IV. Provider business mailing address

1505 NANTAHALA BLVD
MOUNT PLEASANT SC
29464-9751
US

V. Phone/Fax

Practice location:
  • Phone: 843-412-4407
  • Fax:
Mailing address:
  • Phone: 585-298-0453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number275462
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: