Provider Demographics
NPI:1699285353
Name:JAMES, MELODY GILLIAM (RN)
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:GILLIAM
Last Name:JAMES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MELODY
Other - Middle Name:LYNN
Other - Last Name:GILLIAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6350 W ANDREW JOHNSON HWY DEPT 100
Mailing Address - Street 2:
Mailing Address - City:TALBOTT
Mailing Address - State:TN
Mailing Address - Zip Code:37877-8605
Mailing Address - Country:US
Mailing Address - Phone:800-355-3565
Mailing Address - Fax:423-714-2355
Practice Address - Street 1:6350 W ANDREW JOHNSON HWY
Practice Address - Street 2:
Practice Address - City:TALBOTT
Practice Address - State:TN
Practice Address - Zip Code:37877-8605
Practice Address - Country:US
Practice Address - Phone:423-587-7337
Practice Address - Fax:423-586-0614
Is Sole Proprietor?:No
Enumeration Date:2017-10-09
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN83810163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse