MEDICARE: ALEXIS JO BROWN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	36061	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	36061	OTHER	SC	MEDICAL LICENSE

General Provider Information

NPI Number	:	1245670934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXIS JO BROWN MD

Provider Business Mailing Address
First Line	:	PO BOX 421718
Second Line	:
City	:	GEORGETOWN
State	:	SC
Zip	:	29442-4203
Country	:	US
Telephone Number	:	843-652-8226
Fax Number	:

Provider Business Practice Location Address
First Line	:	4301 DICK POND RD
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-6807
Country	:	US
Telephone Number	:	843-652-8100
Fax Number	:	843-652-8122

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2013
Last Update Date	:	03/03/2021

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