Healthcare Provider Details

I. General information

NPI: 1376506634
Provider Name (Legal Business Name): RODGER L MELTON NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2006
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 PROGRESSIVE ST
BLUFFTON SC
29910-5165
US

IV. Provider business mailing address

2000 FRONTIS PLAZA BLVD STE 200 ATTN FORSYTH MEDICAL GROUP
WINSTON SALEM NC
27103-5616
US

V. Phone/Fax

Practice location:
  • Phone: 843-548-0533
  • Fax:
Mailing address:
  • Phone: 336-277-2436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number201374
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: