Provider Demographics
NPI:1528011723
Name:DURHAM, MELINDA SUE (MD)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:SUE
Last Name:DURHAM
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:PO BOX 277827
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-7827
Mailing Address - Country:US
Mailing Address - Phone:864-253-8080
Mailing Address - Fax:864-543-1048
Practice Address - Street 1:2212 OLD FURNACE ROAD
Practice Address - Street 2:
Practice Address - City:BOILING SPRINGS
Practice Address - State:SC
Practice Address - Zip Code:29316
Practice Address - Country:US
Practice Address - Phone:864-578-9735
Practice Address - Fax:864-578-7098
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC16196207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC161960Medicaid
GAP00402267OtherMEDICARE RAILROAD PTAN#
GAP00402267OtherMEDICARE RAILROAD PTAN#
SC161960Medicaid
79F68641Medicare UPIN
SC8688Medicare PIN