Healthcare Provider Details

I. General information

NPI: 1457668774
Provider Name (Legal Business Name): MS. PAMELA BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2010
Last Update Date: 09/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 W LIBERTY ST STE 213
SUMTER SC
29150-4865
US

IV. Provider business mailing address

410 W LIBERTY ST STE 213
SUMTER SC
29150-4865
US

V. Phone/Fax

Practice location:
  • Phone: 803-236-2152
  • Fax:
Mailing address:
  • Phone: 803-236-2152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: