Provider Demographics
NPI:1407083165
Name:WOMICK, MERIDITH MAXWELL (MD)
Entity Type:Individual
Prefix:DR
First Name:MERIDITH
Middle Name:MAXWELL
Last Name:WOMICK
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 1:515 RIVER CROSSING DR
Mailing Address - Street 2:STE 180
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-7900
Mailing Address - Country:US
Mailing Address - Phone:803-578-2800
Mailing Address - Fax:803-578-2810
Practice Address - Street 1:515 RIVER CROSSING DR
Practice Address - Street 2:STE 180
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29715-7900
Practice Address - Country:US
Practice Address - Phone:803-578-2800
Practice Address - Fax:803-578-2810
Is Sole Proprietor?:No
Enumeration Date:2009-06-19
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.098200207P00000X
SC36404207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNC1668Medicaid
SCSC2584C982Medicare PIN