Healthcare Provider Details

I. General information

NPI: 1841833092
Provider Name (Legal Business Name): SAMUEL CHASE BROOKS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2019
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 BLUFF AVE
NORTH AUGUSTA SC
29841-3862
US

IV. Provider business mailing address

150 BLUFF AVE CREDENTIALING DEPT.
NORTH AUGUSTA SC
29841-3862
US

V. Phone/Fax

Practice location:
  • Phone: 803-624-1313
  • Fax:
Mailing address:
  • Phone: 803-624-1313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: