Healthcare Provider Details

I. General information

NPI: 1235167784
Provider Name (Legal Business Name): BRIAN ATHAN ARMSTRONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 01/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 23RD AVE.
ISLE OF PALMS SC
29451
US

IV. Provider business mailing address

17 23RD AVE
ISLE OF PALMS SC
29451
US

V. Phone/Fax

Practice location:
  • Phone: 843-323-9228
  • Fax: 843-885-0892
Mailing address:
  • Phone: 843-323-9228
  • Fax: 843-885-0892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number26509
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: