Provider Demographics
NPI:1932119377
Name:MAGILL, MELISSA MERRILL (MD)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:MERRILL
Last Name:MAGILL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 CHILDRENS WAY # 844
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72202-3500
Mailing Address - Country:US
Mailing Address - Phone:501-364-2090
Mailing Address - Fax:501-364-3929
Practice Address - Street 1:2601 GENE GEORGE BLVD
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-0845
Practice Address - Country:US
Practice Address - Phone:501-364-2090
Practice Address - Fax:501-364-3929
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARE13059208000000X
GA057218208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200902370AMedicaid
AR239398001Medicaid
GA452405206NMedicaid
MO200082724Medicaid