Healthcare Provider Details

I. General information

NPI: 1720191604
Provider Name (Legal Business Name): TERRY ANN MELVIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 10/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5616 BRAINERD RD SUITE 108
CHATTANOOGA TN
37411-5374
US

IV. Provider business mailing address

3626 JOHN SIMS RD
CHATTANOOGA TN
37412-1810
US

V. Phone/Fax

Practice location:
  • Phone: 423-803-1379
  • Fax: 866-493-5813
Mailing address:
  • Phone: 423-802-0028
  • Fax: 866-493-5813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number035951
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number0000000393
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number021452
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number0000000008
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number0000000622
License Number StateTN
# 6
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number0000000009
License Number StateTN
# 7
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number146-207-H
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: