=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952470643
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEW DAY FAMILY PRACTICE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/07/2006
-----------------------------------------------------
Last Update Date | 04/13/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 104 N WOODLAND DR STE D
-----------------------------------------------------
City | LANCASTER
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29720-4778
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-285-5441
-----------------------------------------------------
Fax | 803-285-7509
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 820 W MEETING ST
-----------------------------------------------------
City | LANCASTER
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29720-2202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-285-5441
-----------------------------------------------------
Fax | 803-285-7509
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF PROVIDER ENROLLMENT
-----------------------------------------------------
Name | DEBBIE T BREWER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 615-465-7626
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------