Healthcare Provider Details

I. General information

NPI: 1699771972
Provider Name (Legal Business Name): MELISSA S. MCCARTER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA S FORD FND

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 10/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

529 MILLS AVE AGAPE SENIOR PRIMARY CARE, INC.
GREENVILLE SC
29201-2818
US

IV. Provider business mailing address

1624 MAIN STREET AGAPE SENIOR PRIMARY CARE, INC.
COLUMBIA SC
29201-2818
US

V. Phone/Fax

Practice location:
  • Phone: 803-726-2350
  • Fax: 803-753-9102
Mailing address:
  • Phone: 803-726-2350
  • Fax: 803-753-9102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1843
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: