Provider Demographics
NPI:1164403887
Name:LOGAN, MELISSA SIMS (MD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:SIMS
Last Name:LOGAN
Suffix:
Gender:F
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:PO BOX 1869
Mailing Address - Street 2:
Mailing Address - City:FLETCHER
Mailing Address - State:NC
Mailing Address - Zip Code:28732-1869
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:828-650-8076
Practice Address - Street 1:50 HOSPITAL DR STE 1C
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-5250
Practice Address - Country:US
Practice Address - Phone:828-687-9758
Practice Address - Fax:828-687-9764
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA076273208600000X
NC2012-02224208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHY520ZMedicare PIN