Healthcare Provider Details

I. General information

NPI: 1427076454
Provider Name (Legal Business Name): EVANGELINE JOY BROWN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EVANGELINE JOY STEPHENS

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 05/18/2022
Certification Date: 05/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 RICHLAND MEDICAL PARK DR STE 215
COLUMBIA SC
29203-6863
US

IV. Provider business mailing address

PO BOX 743904
ATLANTA GA
30374-3904
US

V. Phone/Fax

Practice location:
  • Phone: 803-434-3533
  • Fax: 803-434-3094
Mailing address:
  • Phone: 864-797-6220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number080644
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberME108966
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number27975
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: