Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 13580 | SC |
N | 207QA0401X | Family Doctor - Addiction Medicine | 13580 | SC |
NPI | 1316099195 |
---|---|
Provider Name | Marshall L Meadors III |
First Address | Anderson, SC 29621-1580 |
Second Address | Anderson, SC 29621-1580 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2007 |
Last Update Date | 24/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
135801 | (05) | SC |
B91960 | (02) | SC |