Healthcare Provider Details

I. General information

NPI: 1992230387
Provider Name (Legal Business Name): CAROLINE PATRICIA BROOKS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2017
Last Update Date: 10/04/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 GROVE RD FL 5
GREENVILLE SC
29605-4210
US

IV. Provider business mailing address

300 E MCBEE AVE FL 4
GREENVILLE SC
29601-2842
US

V. Phone/Fax

Practice location:
  • Phone: 864-455-4411
  • Fax: 864-455-4480
Mailing address:
  • Phone: 864-522-8617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number51178
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: