Provider Demographics
NPI:1063647717
Name:GADSON, MELVIN ELLIOTT (PT)
Entity Type:Individual
Prefix:MR
First Name:MELVIN
Middle Name:ELLIOTT
Last Name:GADSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 WARWICK CT
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29154-7273
Mailing Address - Country:US
Mailing Address - Phone:803-840-3734
Mailing Address - Fax:803-883-4960
Practice Address - Street 1:70 WARWICK CT
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29154-7273
Practice Address - Country:US
Practice Address - Phone:803-840-3734
Practice Address - Fax:803-883-4960
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-26
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4295172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker