Healthcare Provider Details

I. General information

NPI: 1215608484
Provider Name (Legal Business Name): ALEXANDER MELKONIAN PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2021
Last Update Date: 02/06/2026
Certification Date: 02/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 MEDICAL PARK BLVD
BRISTOL TN
37620-7343
US

IV. Provider business mailing address

708 W MAPLE ST
JOHNSON CITY TN
37604-6508
US

V. Phone/Fax

Practice location:
  • Phone: 540-272-9242
  • Fax:
Mailing address:
  • Phone: 540-272-9242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3841
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3841
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: