Basic Information
| Provider Information | |||||||||
| NPI: | 1316918204 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MEMON | ||||||||
| FirstName: | MOHAMMED | ||||||||
| MiddleName: | AMIN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2700 E PHILLIPS RD | ||||||||
| Address2: | |||||||||
| City: | GREER | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296504815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8642352335 | ||||||||
| FaxNumber: | 8648771260 | ||||||||
| Practice Location | |||||||||
| Address1: | 2700 E PHILLIPS RD | ||||||||
| Address2: | |||||||||
| City: | GREER | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296504815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8642352335 | ||||||||
| FaxNumber: | 8648771260 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2006 | ||||||||
| LastUpdateDate: | 07/28/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 21758 | SC | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0805X | 21758 | SC | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Geriatric Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 260046979 | 01 | SC | RAILROAD MEDICARE | OTHER | 217580 | 05 | SC | MEDICAID | A8239 | 01 | SC | MEDCOST | OTHER | 89064X8 | 05 | NC | MEDICAID |