Healthcare Provider Details

I. General information

NPI: 1932188372
Provider Name (Legal Business Name): DARRYL LYNN MCLEOD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 09/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 SPRING ST
GREENWOOD SC
29646-3860
US

IV. Provider business mailing address

1325 SPRING ST
GREENWOOD SC
29646-3860
US

V. Phone/Fax

Practice location:
  • Phone: 864-725-4822
  • Fax: 864-725-4679
Mailing address:
  • Phone: 804-350-2889
  • Fax: 804-545-0652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number14715
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: