Provider Demographics
NPI:1215956800
Name:WILLS, MELANIE H (MD)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:H
Last Name:WILLS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8614
Mailing Address - Fax:864-512-1823
Practice Address - Street 1:20 MEDICAL RIDGE DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4267
Practice Address - Country:US
Practice Address - Phone:864-220-7270
Practice Address - Fax:864-241-9211
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA049598208000000X
SC52224208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC522241Medicaid
GA117470OtherPEACHSTATE MEDICAID
GA377006OtherWELLCARE MEDICAID
GA830854OtherBCBS GEORGIA
GA300035719AMedicaid