Healthcare Provider Details

I. General information

NPI: 1346004215
Provider Name (Legal Business Name): BRANTLEY MICHAEL ADAMS JR. APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2024
Last Update Date: 02/26/2025
Certification Date: 01/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1278 N. LAFAYETTE DR.
SUMTER SC
29150-2964
US

IV. Provider business mailing address

550 S. PIKE WEST
SUMTER SC
29150-2616
US

V. Phone/Fax

Practice location:
  • Phone: 803-774-4500
  • Fax: 803-774-4650
Mailing address:
  • Phone: 803-324-6975
  • Fax: 803-324-6975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number29391
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: