Healthcare Provider Details

I. General information

NPI: 1598953705
Provider Name (Legal Business Name): MEREDITH MCLAIN GRIFFIN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2007
Last Update Date: 10/29/2020
Certification Date: 10/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2093 HENRY TECKLENBURG DR STE 300E
CHARLESTON SC
29414-5743
US

IV. Provider business mailing address

PO BOX 751649
CHARLOTTE NC
28275-1649
US

V. Phone/Fax

Practice location:
  • Phone: 843-724-2011
  • Fax: 843-606-7991
Mailing address:
  • Phone: 843-789-1620
  • Fax: 843-724-2440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1255
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: