Provider Demographics
NPI:1336434182
Name:MCADAMS, BROOKE SHAVON (MD)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:SHAVON
Last Name:MCADAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:SHAVON
Other - Last Name:HOLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2 MEDICAL PARK ROAD
Practice Address - Street 2:SUITE 506
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203
Practice Address - Country:US
Practice Address - Phone:803-434-3930
Practice Address - Fax:803-933-3035
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL33538207R00000X
SC33538207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC335382Medicaid
SC335382Medicaid
SCSC88952603Medicare PIN