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General NPI Number Information
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NPI Number | 1992186027
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Entity Type | Individual
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Provider Name | MAYADA ELIAN MD
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Gender | Female
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Dates
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Enumeration Date | 06/15/2015
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Last Update Date | 09/25/2024
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Provider Practice Location Address
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Address Line | 110 HIGHWAY 246 N
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City | GREENWOOD
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State | SC
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Zip | 29649-8748
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Country | US
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Telephone | 864-725-1750
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Fax | 864-725-1762
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Provider Business Mailing Address
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Address Line | 104 WELLS AVE
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City | GREENWOOD
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State | SC
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Zip | 29646-3837
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Country | US
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Telephone | 864-725-4673
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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 | 51831
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 84753
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License Number State | SC
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