Provider Demographics
NPI:1760722029
Name:BROWN, GERALD ALAN LEE (APRN)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:ALAN LEE
Last Name:BROWN
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 FRANKLIN SQUARE WAY STE A
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29642-3715
Mailing Address - Country:US
Mailing Address - Phone:864-442-4110
Mailing Address - Fax:864-442-4126
Practice Address - Street 1:105 FRANKLIN SQUARE WAY STE A
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29642-3715
Practice Address - Country:US
Practice Address - Phone:864-442-4110
Practice Address - Fax:864-442-4126
Is Sole Proprietor?:No
Enumeration Date:2013-02-25
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18186363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSC0701Medicare PIN