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General NPI Number Information
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NPI Number | 1861463432
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Entity Type | Individual
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Provider Name | MELTON R. STUCKEY MD
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Gender | Male
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Dates
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Enumeration Date | 01/31/2006
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Last Update Date | 12/09/2019
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Provider Practice Location Address
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Address Line | 1415 BLANDING STREET SUITE 2
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City | COLUMBIA
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State | SC
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Zip | 29201
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Country | US
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Telephone | 803-256-1518
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Fax | 803-256-9719
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Provider Business Mailing Address
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Address Line | 201 SIGMA DR STE 100
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City | SUMMERVILLE
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State | SC
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Zip | 29486-7722
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Country | US
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Telephone | 843-695-6071
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Fax | 843-569-5879
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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 | 5408
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | 5408
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License Number State | SC
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