Provider Demographics
NPI:1538111760
Name:FLOYD, MEREDITH DIANE (MD)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:DIANE
Last Name:FLOYD
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 530062
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30353-0062
Mailing Address - Country:US
Mailing Address - Phone:436-985-6071
Mailing Address - Fax:843-569-5879
Practice Address - Street 1:115 EXECUTIVE PARKWAY
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461
Practice Address - Country:US
Practice Address - Phone:843-761-2815
Practice Address - Fax:843-899-4723
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22046207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC080157308OtherMEDICARE RAIL ROAD
SCT62198Medicaid
SCAA59687126Medicare PIN
SCG89346Medicare UPIN
SC080157308OtherMEDICARE RAIL ROAD