Healthcare Provider Details

I. General information

NPI: 1174107924
Provider Name (Legal Business Name): LAUREN MELLEY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2021
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 HIGHWAY 280 S STE 300W
MOUNTAIN BRK AL
35223-2445
US

IV. Provider business mailing address

2700 HIGHWAY 280 S STE 300W
MOUNTAIN BRK AL
35223-2445
US

V. Phone/Fax

Practice location:
  • Phone: 205-930-9595
  • Fax:
Mailing address:
  • Phone: 205-930-9595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberDO.4582
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: