Healthcare Provider Details

I. General information

NPI: 1598673303
Provider Name (Legal Business Name): LEVI BRICE JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

546 ANDERSON RD N
ROCK HILL SC
29730-3322
US

IV. Provider business mailing address

1013 EQUIPOISE DR
INDIAN TRAIL NC
28079-8493
US

V. Phone/Fax

Practice location:
  • Phone: 803-579-5809
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: