Healthcare Provider Details

I. General information

NPI: 1457954745
Provider Name (Legal Business Name): ELENA DIMITRIEVNA BROWN FIRST ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2020
Last Update Date: 11/18/2020
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 LENA DR
EASLEY SC
29640-9648
US

IV. Provider business mailing address

1 SAINT FRANCIS DR
GREENVILLE SC
29601-3955
US

V. Phone/Fax

Practice location:
  • Phone: 678-559-4988
  • Fax:
Mailing address:
  • Phone: 864-255-1073
  • Fax: 864-255-1929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number2086S0129X
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code2086H0002X
TaxonomyHospice and Palliative Medicine (Surgery) Physician
License Number2086H0002X
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number2086X0206X
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code2088F0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Urology) Physician
License Number2088F0040X
License Number StateSC
# 5
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number208G00000X
License Number StateSC
# 6
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number2086S0127X
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: