Healthcare Provider Details

I. General information

NPI: 1548243041
Provider Name (Legal Business Name): DAVID ALLEN MELSON CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 11/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 WESTMORELAND RD
GREER SC
29651-9013
US

IV. Provider business mailing address

PO BOX 19886
ATLANTA GA
30384-8806
US

V. Phone/Fax

Practice location:
  • Phone: 864-530-2108
  • Fax:
Mailing address:
  • Phone: 864-560-4123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR86557
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: