1821006669 NPI number — DAVID A FLEMING MD

Table of content: DAVID A FLEMING MD (NPI 1821006669)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821006669 NPI number — DAVID A FLEMING MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FLEMING
Provider First Name:
DAVID
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821006669
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/01/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 DOCTORS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENVILLE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29605-4266
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-250-6510
Provider Business Mailing Address Fax Number:
864-250-6475

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 HALTON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29607-3403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
964-458-3983
Provider Business Practice Location Address Fax Number:
864-458-3893
Provider Enumeration Date:
08/04/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  20-35380 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207L00000X , with the licence number: 036713 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207L00000X , with the licence number: 15311 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207L00000X , with the licence number: 2012-2332 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000557268K , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 050038359 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 333556 . This is a "WELLCARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 000557268L , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00557268F , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000557268J , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".