Healthcare Provider Details

I. General information

NPI: 1346578390
Provider Name (Legal Business Name): BONNIE FAYE BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2009
Last Update Date: 12/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7269 LAW ROAD
EFFINGHAM SC
29541
US

IV. Provider business mailing address

7269 LAW RD.
EFFINGHAM SC
29541
US

V. Phone/Fax

Practice location:
  • Phone: 843-303-5232
  • Fax: 843-493-6030
Mailing address:
  • Phone: 843-303-5232
  • Fax: 843-493-6030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: