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General NPI Number Information
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NPI Number | 1831445998
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Entity Type | Organization
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Legal Business Name | LAKE CITY FAMILY MEDICINE, LLC
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Dates
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Enumeration Date | 07/26/2012
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Last Update Date | 10/11/2012
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Provider Practice Location Address
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Address Line | 505 THURGOOD MARSHALL HWY
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City | KINGSTREE
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State | SC
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Zip | 29556-4107
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Country | US
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Telephone | 843-374-8380
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Fax |
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Provider Business Mailing Address
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Address Line | 901 N MATTHEWS RD
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City | LAKE CITY
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State | SC
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Zip | 29560-7024
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Country | US
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Telephone | 843-374-5247
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MORRIS EDWARD BROWN III
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Credential | M.D.
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Telephone | 843-374-8380
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | 17100
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License Number State | SC
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