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General NPI Number Information
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NPI Number | 1568176709
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Entity Type | Individual
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Provider Name | TINA COLYAR MEREE
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Gender | Female
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Dates
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Enumeration Date | 01/12/2023
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Last Update Date | 08/29/2023
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Provider Practice Location Address
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Address Line | 102 LEE ST
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City | MONCKS CORNER
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State | SC
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Zip | 29461-4423
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Country | US
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Telephone | 843-412-3541
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Fax |
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Provider Business Mailing Address
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Address Line | 9995 MILES JAMISON RD
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City | SUMMERVILLE
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State | SC
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Zip | 29485-4423
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Country | US
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Telephone | 843-821-5808
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 26830
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License Number State | SC
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