Basic Information
Provider Information
NPI: 1144411331
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PATTON
FirstName: MELISSA
MiddleName: ANNE
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5301 VIRGINIA WAY
Address2: SUITE 300
City: BRENTWOOD
State: TN
PostalCode: 370277541
CountryCode: US
TelephoneNumber: 6152214474
FaxNumber: 6152343774
Practice Location
Address1: 5301 VIRGINIA WAY
Address2: SUITE 300
City: BRENTWOOD
State: TN
PostalCode: 370277541
CountryCode: US
TelephoneNumber: 6152214474
FaxNumber: 6152343774
Other Information
ProviderEnumerationDate: 08/05/2007
LastUpdateDate: 08/05/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207ZP0101XBP1-0029088TXN Allopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
207ZP0102X036133536ILY Allopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology

ID Information
IDTypeStateIssuerDescription
467003120601 MYUTMB 4670031206OTHER


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