Healthcare Provider Details

I. General information

NPI: 1639199201
Provider Name (Legal Business Name): MELISSA K RICHARDSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA K ROBERSON MD

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 HALTON RD
GREENVILLE SC
29607-3508
US

IV. Provider business mailing address

PO BOX 631341
CINCINNATI OH
45263-1341
US

V. Phone/Fax

Practice location:
  • Phone: 864-234-7654
  • Fax: 888-412-1282
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number20894
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: