Individual
STEPHANIE BROOKE PROVOST JOHNSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
890 W FARIS RD, SUITE 470, GREENVILLE, SC 29605-4253
(864) 455-5938
Mailing address
1 INDEPENDENCE PT, SUITE 212, GREENVILLE, SC 29615-4545
(864) 797-6044
(864) 797-6198
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
68041741205
UT
2080H0002X
Pediatric Hospice and Palliative Medicine Physician
Primary
36228
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
362280
—
SC
Enumeration date
01/22/2008
Last updated
01/30/2024
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