Provider Demographics
NPI:1316918204
Name:MEMON, MOHAMMED AMIN (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:AMIN
Last Name:MEMON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 E PHILLIPS RD
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-4815
Mailing Address - Country:US
Mailing Address - Phone:864-235-2335
Mailing Address - Fax:864-877-1260
Practice Address - Street 1:2700 E PHILLIPS RD
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-4815
Practice Address - Country:US
Practice Address - Phone:864-235-2335
Practice Address - Fax:864-877-1260
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC217582084P0800X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC260046979OtherRAILROAD MEDICARE
SC217580Medicaid
SCA8239OtherMEDCOST
NC89064X8Medicaid
SCH36215Medicare PIN
SCA8239OtherMEDCOST
SCH36215Medicare UPIN