Healthcare Provider Details

I. General information

NPI: 1922637735
Provider Name (Legal Business Name): MELINDA MARIE TALLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2020
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9150 MEDCOM ST STE B
NORTH CHARLESTON SC
29406-9196
US

IV. Provider business mailing address

169 ASHLEY AVE RM 202
CHARLESTON SC
29425-8905
US

V. Phone/Fax

Practice location:
  • Phone: 843-572-3330
  • Fax:
Mailing address:
  • Phone: 251-382-5623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberT-4052
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number90437
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: