Healthcare Provider Details

I. General information

NPI: 1205833142
Provider Name (Legal Business Name): HEATHER ANNE MELTON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER ANNE GULISH MD

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 07/13/2023
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22700 HIGHWAY 22 STE A
MC KENZIE TN
38201-8679
US

IV. Provider business mailing address

965 RIDGE LAKE BLVD STE 315
MEMPHIS TN
38120-9401
US

V. Phone/Fax

Practice location:
  • Phone: 731-986-7200
  • Fax: 731-986-7292
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number37119
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: