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General NPI Number Information
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NPI Number | 1710065271
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Entity Type | Individual
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Provider Name | JOYCE M BRACKEBUSCH MD
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Gender | Female
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 01/17/2024
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Provider Practice Location Address
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Address Line | 146 E HOSPITAL DR STE 200
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City | WEST COLUMBIA
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State | SC
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Zip | 29169-4800
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Country | US
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Telephone | 803-936-7530
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Fax | 803-936-7532
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Provider Business Mailing Address
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Address Line | PO BOX 6069
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City | WEST COLUMBIA
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State | SC
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Zip | 29171-6069
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Country | US
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Telephone | 803-791-2000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | MD20476
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 89330
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License Number State | SC
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