Provider Demographics
NPI:1487741583
Name:MELVIN, WILLIE (MD)
Entity type:Individual
Prefix:
First Name:WILLIE
Middle Name:
Last Name:MELVIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:410 42ND AVE N STE 400
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-3658
Mailing Address - Country:US
Mailing Address - Phone:615-329-7887
Mailing Address - Fax:615-346-6225
Practice Address - Street 1:515 STONECREST PKWY STE 230
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-6829
Practice Address - Country:US
Practice Address - Phone:615-223-9935
Practice Address - Fax:615-891-5046
Is Sole Proprietor?:No
Enumeration Date:2006-10-09
Last Update Date:2024-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TNMD26734208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
G09823Medicare UPIN