MEDICARE: MELODY CAMILLE THARP MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD38650	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3706633	OTHER	TN	MEDICARE GROUP

General Provider Information

NPI Number	:	1396743571
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELODY CAMILLE THARP MD

Provider Business Mailing Address
First Line	:	1225 E WEISGARBER RD
Second Line	:	SUITE 200
City	:	KNOXVILLE
State	:	TN
Zip	:	37909-2604
Country	:	US
Telephone Number	:	865-584-4747
Fax Number	:	865-584-1363

Provider Business Practice Location Address
First Line	:	121 FRANK DIGGS ROAD
Second Line	:
City	:	CLINTON
State	:	TN
Zip	:	37716
Country	:	US
Telephone Number	:	865-457-8840
Fax Number	:	865-463-0756

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	07/13/2011

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