Healthcare Provider Details

I. General information

NPI: 1760301741
Provider Name (Legal Business Name): DR. MELANIE JOHNSON MCKINNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 LAKESHORE DR
LINCOLN AL
35096-6041
US

IV. Provider business mailing address

32 LAKESHORE DR
LINCOLN AL
35096-6041
US

V. Phone/Fax

Practice location:
  • Phone: 256-749-6233
  • Fax:
Mailing address:
  • Phone: 256-749-6233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberALC05255
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: