Provider Demographics
NPI:1730379132
Name:BROWN-RAWLS, DEJUANIA ANGELA (DO)
Entity type:Individual
Prefix:DR
First Name:DEJUANIA
Middle Name:ANGELA
Last Name:BROWN-RAWLS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8121 ROURK ST
Mailing Address - Street 2:ATT: HR DEPARTMENT
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-4128
Mailing Address - Country:US
Mailing Address - Phone:843-429-5051
Mailing Address - Fax:843-429-5053
Practice Address - Street 1:8121 ROURK ST
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-4128
Practice Address - Country:US
Practice Address - Phone:843-692-5000
Practice Address - Fax:843-692-5010
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC39906207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200954550Medicaid
INP01014243OtherRR MEDICARE
IN200954550Medicaid