Provider Demographics
NPI:1275264467
Name:FIELDS, MEGAN SYMONE
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:SYMONE
Last Name:FIELDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1823
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29484-1823
Mailing Address - Country:US
Mailing Address - Phone:843-603-2258
Mailing Address - Fax:
Practice Address - Street 1:2178 SAVANNAH HWY UNIT I
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-5311
Practice Address - Country:US
Practice Address - Phone:843-603-2258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
9993973374U00000X
SC9993973376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC5366Medicaid