Healthcare Provider Details

I. General information

NPI: 1538326434
Provider Name (Legal Business Name): MELISSA ANNE KATH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2008
Last Update Date: 09/07/2022
Certification Date: 09/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 HUMPHREYS CENTER DR STE 100
MEMPHIS TN
38120-2352
US

IV. Provider business mailing address

8110 N BROTHER BLVD STE 200
BARTLETT TN
38133-2760
US

V. Phone/Fax

Practice location:
  • Phone: 901-761-9030
  • Fax: 901-761-9030
Mailing address:
  • Phone: 901-255-5221
  • Fax: 901-373-4511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number4301104502
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number56832
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: