Healthcare Provider Details

I. General information

NPI: 1033644414
Provider Name (Legal Business Name): MICHELLE MILLER MATTHEWS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2017
Last Update Date: 10/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 GROVE RD 5TH FLOOR BALCONY SUITE
GREENVILLE SC
29605-4210
US

IV. Provider business mailing address

1 INDEPENDENCE PT STE 212
GREENVILLE SC
29615-4536
US

V. Phone/Fax

Practice location:
  • Phone: 864-455-7895
  • Fax: 864-455-7807
Mailing address:
  • Phone: 864-797-6306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number51157
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: