MEDICARE: DR. JEFFERY HALL BRANDENBURG 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	208M00000X	Hospitalist Physician	16751	SC
2	2084P0800X	Psychiatry Physician	16751	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659345379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFERY HALL BRANDENBURG MD

Provider Business Mailing Address
First Line	:	300 E MCBEE AVE FL 4
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29601-2842
Country	:	US
Telephone Number	:	803-296-7320
Fax Number	:	803-296-7330

Provider Business Practice Location Address
First Line	:	11 RICHLAND MEDICAL PARK DR
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29203-6863
Country	:	US
Telephone Number	:	803-434-4300
Fax Number	:	803-434-4351

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

Provider Enumeration Date	:	02/17/2006
Last Update Date	:	12/21/2022

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