Healthcare Provider Details

I. General information

NPI: 1760722029
Provider Name (Legal Business Name): GERALD ALAN LEE BROWN APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2013
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 FRANKLIN SQUARE WAY STE A
EASLEY SC
29642-3715
US

IV. Provider business mailing address

105 FRANKLIN SQUARE WAY STE A
EASLEY SC
29642-3715
US

V. Phone/Fax

Practice location:
  • Phone: 864-442-4110
  • Fax: 864-442-4126
Mailing address:
  • Phone: 864-442-4110
  • Fax: 864-442-4126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number18186
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: