Healthcare Provider Details

I. General information

NPI: 1366276701
Provider Name (Legal Business Name): AMELIA NEWELL BRAKEFIELD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2024
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 E PARK AVE
GREENVILLE SC
29601-1629
US

IV. Provider business mailing address

11 E PARK AVE
GREENVILLE SC
29601-1629
US

V. Phone/Fax

Practice location:
  • Phone: 864-233-2270
  • Fax: 864-235-4327
Mailing address:
  • Phone: 864-233-2270
  • Fax: 864-235-4327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code156FX1700X
TaxonomyOcularist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: