Provider Demographics
NPI:1457669103
Name:MUNSON, MAURICE (MEDICAL ASSISTANT)
Entity Type:Individual
Prefix:
First Name:MAURICE
Middle Name:
Last Name:MUNSON
Suffix:
Gender:M
Credentials:MEDICAL ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 ADAMS SCOTT RD
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:SC
Mailing Address - Zip Code:29052-9631
Mailing Address - Country:US
Mailing Address - Phone:803-315-9075
Mailing Address - Fax:
Practice Address - Street 1:300 ADAMS SCOTT RD
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:SC
Practice Address - Zip Code:29052-9631
Practice Address - Country:US
Practice Address - Phone:803-315-9075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide