Provider Demographics
NPI:1114097458
Name:SEYMORE, MELVINIE (MD)
Entity Type:Individual
Prefix:MS
First Name:MELVINIE
Middle Name:
Last Name:SEYMORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MELVINIE
Other - Middle Name:
Other - Last Name:SEYMORE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1469 POPLAR AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104
Mailing Address - Country:US
Mailing Address - Phone:901-276-3222
Mailing Address - Fax:901-276-1398
Practice Address - Street 1:7705 POPLAR AVE.
Practice Address - Street 2:BLDG B STE 110
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138
Practice Address - Country:US
Practice Address - Phone:901-755-8696
Practice Address - Fax:901-755-7232
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN018497207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3030099Medicaid
TN3030099Medicaid
A99402Medicare UPIN