Provider Demographics
NPI:1366276701
Name:BRAKEFIELD, AMELIA NEWELL
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:NEWELL
Last Name:BRAKEFIELD
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 1:11 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-1629
Mailing Address - Country:US
Mailing Address - Phone:864-233-2270
Mailing Address - Fax:864-235-4327
Practice Address - Street 1:11 E PARK AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-1629
Practice Address - Country:US
Practice Address - Phone:864-233-2270
Practice Address - Fax:864-235-4327
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularist