Provider Demographics
NPI:1871655431
Name:KNEELAND, MELODY JAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MELODY
Middle Name:JAN
Last Name:KNEELAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MELODY
Other - Middle Name:JAN
Other - Last Name:SNYDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:219 BATESVILLE RD
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-4816
Practice Address - Country:US
Practice Address - Phone:864-849-9170
Practice Address - Fax:864-849-9193
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23555207Q00000X
SC28555207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSCL076J577OtherMEDICARE PIN
SC285550Medicaid
SCPO1278181OtherRAILROAD MEDICARE
SCSCL0766084OtherMEDICARE PIN
SCSCL0766067OtherMEDICARE PIN