Provider Demographics
NPI:1831813526
Name:BILLIOT, MACI BROOKE (PA)
Entity type:Individual
Prefix:
First Name:MACI
Middle Name:BROOKE
Last Name:BILLIOT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 E STONE AVE APT 307
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2263
Mailing Address - Country:US
Mailing Address - Phone:713-540-7507
Mailing Address - Fax:
Practice Address - Street 1:200 PATEWOOD DR STE B300
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-6338
Practice Address - Country:US
Practice Address - Phone:864-454-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-27
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4605363A00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant