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General NPI Number Information
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NPI Number | 1497220321
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Entity Type | Individual
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Provider Name | MELISSA LOGOS CMF
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Gender | Female
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Dates
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Enumeration Date | 10/08/2018
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Last Update Date | 10/08/2018
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Provider Practice Location Address
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Address Line | 9138 CARL LEGETT RD STE C
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City | GULFPORT
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State | MS
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Zip | 39503-6262
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Country | US
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Telephone | 228-896-3688
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Fax | 228-896-3688
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Provider Business Mailing Address
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Address Line | 9138 CARL LEGETT RD STE C
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City | GULFPORT
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State | MS
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Zip | 39503-6262
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Country | US
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Telephone | 228-896-3688
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Fax | 228-896-3688
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224900000X
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Taxonomy Name | Mastectomy Fitter
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License Number |
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License Number State |
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