Provider Demographics
NPI:1245278480
Name:MILLS, MELISSA L (MD)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:L
Last Name:MILLS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 CLEMSON RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-4341
Mailing Address - Country:US
Mailing Address - Phone:803-788-6146
Mailing Address - Fax:803-463-0312
Practice Address - Street 1:7448 BROAD RIVER ROAD
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063
Practice Address - Country:US
Practice Address - Phone:803-732-0140
Practice Address - Fax:803-463-0312
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23226208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC23226OtherSC MEDICAL LIC #
SCI15359Medicare UPIN