Provider Demographics
NPI:1346785466
Name:NEAL, MARY
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:NEAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 S LEACH ST
Mailing Address - Street 2:410 MAULDIN RIAD
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-3233
Mailing Address - Country:US
Mailing Address - Phone:864-325-7131
Mailing Address - Fax:864-243-8531
Practice Address - Street 1:410 MAULDIN RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-1323
Practice Address - Country:US
Practice Address - Phone:864-325-7131
Practice Address - Fax:864-243-8531
Is Sole Proprietor?:No
Enumeration Date:2016-12-28
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide