Basic Information
| Provider Information | |||||||||
| NPI: | 1073952909 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRAZELL | ||||||||
| FirstName: | MEREDITH | ||||||||
| MiddleName: | JOHNSTON | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3788 | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292303788 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037335969 | ||||||||
| FaxNumber: | 8037535591 | ||||||||
| Practice Location | |||||||||
| Address1: | 120 PALENCIA VILLAGE DR STE 107 | ||||||||
| Address2: | |||||||||
| City: | ST AUGUSTINE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320958553 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9048193200 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2013 | ||||||||
| LastUpdateDate: | 12/31/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/31/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | OS15757 | FL | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.