Provider Demographics
NPI:1487610507
Name:DAVIDSON, MELANIE R (MD)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:R
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 COOLIDGE ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37743-4672
Mailing Address - Country:US
Mailing Address - Phone:423-278-1842
Mailing Address - Fax:423-278-1844
Practice Address - Street 1:1021 COOLIDGE ST
Practice Address - Street 2:SUITE 5
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37743-4672
Practice Address - Country:US
Practice Address - Phone:423-278-1842
Practice Address - Fax:423-278-1844
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD37717207RC0000X
VA0101237859207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ003719Medicaid
TN103I063987Medicare PIN
TNQ003719Medicaid