Healthcare Provider Details

I. General information

NPI: 1326078676
Provider Name (Legal Business Name): MELISSA PEREZ MACEDA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 12/10/2021
Certification Date: 12/10/2021
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: 864-725-4398
  • Fax: 864-725-4399
Mailing address:
  • Phone: 864-725-4398
  • Fax: 864-725-4399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number20845
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: