Provider Demographics
NPI:1346578390
Name:BROWN, BONNIE FAYE
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:FAYE
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7269 LAW RD.
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:SC
Mailing Address - Zip Code:29541
Mailing Address - Country:US
Mailing Address - Phone:843-303-5232
Mailing Address - Fax:843-493-6030
Practice Address - Street 1:7269 LAW ROAD
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:SC
Practice Address - Zip Code:29541
Practice Address - Country:US
Practice Address - Phone:843-303-5232
Practice Address - Fax:843-493-6030
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-03
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies