Healthcare Provider Details

I. General information

NPI: 1043625262
Provider Name (Legal Business Name): ERIC VASHON BROWN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2014
Last Update Date: 07/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 GROVE RD BALCONY SUITE 5
GREENVILLE SC
29605-4210
US

IV. Provider business mailing address

701 GROVE RD BALCONY SUITE 5
GREENVILLE SC
29605-4210
US

V. Phone/Fax

Practice location:
  • Phone: 864-455-7895
  • Fax: 864-455-7807
Mailing address:
  • Phone: 864-455-7895
  • Fax: 864-455-7807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberLL37266
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: