Individual
LARRY B. MELLICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
14 RICHLAND MEDICAL PARK DR STE 350, COLUMBIA, SC 29203-6896
(803) 434-1663
(803) 434-1663
Mailing address
300 E MCBEE AVE STE 300, GREENVILLE, SC 29601-2899
(864) 522-8603
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
22864
SC
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
042892
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000729319A
—
GA
05
—
G60514
—
SC
Enumeration date
08/30/2006
Last updated
03/26/2026
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