Provider Demographics
NPI:1003888082
Name:BRADLEY, MELITA MELSON (MD)
Entity Type:Individual
Prefix:
First Name:MELITA
Middle Name:MELSON
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MELITA
Other - Middle Name:FAYE
Other - Last Name:MELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3626 SHELBYVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37127-6382
Mailing Address - Country:US
Mailing Address - Phone:615-893-4480
Mailing Address - Fax:615-867-7951
Practice Address - Street 1:3626 SHELBYVILLE HWY
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37127-6382
Practice Address - Country:US
Practice Address - Phone:615-893-4480
Practice Address - Fax:615-867-7951
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD31444208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
G87711Medicare UPIN
3836680Medicare ID - Type Unspecified