Provider Demographics
NPI:1003815572
Name:MELSON, DANNY L (MD)
Entity Type:Individual
Prefix:
First Name:DANNY
Middle Name:L
Last Name:MELSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 N MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:SHELBYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37160-2303
Mailing Address - Country:US
Mailing Address - Phone:931-684-8686
Mailing Address - Fax:931-684-8687
Practice Address - Street 1:1701 N MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160-2303
Practice Address - Country:US
Practice Address - Phone:931-684-8686
Practice Address - Fax:931-684-8687
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000012172208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3183795Medicare ID - Type Unspecified
B04095Medicare UPIN