1174661441 NPI number — MRS. MELISSA ANN DOAN MED

Table of content: MRS. MELISSA ANN DOAN MED (NPI 1174661441)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174661441 NPI number — MRS. MELISSA ANN DOAN MED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOAN
Provider First Name:
MELISSA
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MED
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COCHRAN
Provider Other First Name:
MELISSA
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
MED
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1174661441
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9054
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAY
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37615-9054
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-467-3600
Provider Business Mailing Address Fax Number:
423-467-3696

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ROUTE 3 BOX 1700
Provider Second Line Business Practice Location Address:
LEE COUNTY BEHAVIORAL HEALTH
Provider Business Practice Location Address City Name:
JONESVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24263
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
276-346-3590
Provider Business Practice Location Address Fax Number:
276-346-3612
Provider Enumeration Date:
02/01/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)