Provider Demographics
NPI:1144540428
Name:MCFADDIN, COURTNEY LEE (MD)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:LEE
Last Name:MCFADDIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:MICHELLE
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:28 MEDICAL RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-4267
Mailing Address - Country:US
Mailing Address - Phone:864-271-7440
Mailing Address - Fax:864-271-6001
Practice Address - Street 1:28 MEDICAL RIDGE DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4267
Practice Address - Country:US
Practice Address - Phone:864-271-7440
Practice Address - Fax:864-271-6001
Is Sole Proprietor?:No
Enumeration Date:2010-06-09
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC32736207N00000X, 207ND0900X
SCLL32736207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1144540428OtherNPI
SC327364Medicaid