Basic Information
| Provider Information | |||||||||
| NPI: | 1023143740 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROBBINS | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 294 SUMMAR DRIVE | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383013915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7314231932 | ||||||||
| FaxNumber: | 7314234919 | ||||||||
| Practice Location | |||||||||
| Address1: | 294 SUMMAR DRIVE | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383013915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7314231932 | ||||||||
| FaxNumber: | 7314234919 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2007 | ||||||||
| LastUpdateDate: | 09/12/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD0000042096 | TN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | MD42096 | 01 | TN | LICENSE | OTHER |