Provider Demographics
NPI:1205833142
Name:MELTON, HEATHER ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:ANNE
Last Name:MELTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:HEATHER
Other - Middle Name:ANNE
Other - Last Name:GULISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:965 RIDGE LAKE BLVD STE 315
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-9401
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22700 HIGHWAY 22 STE A
Practice Address - Street 2:
Practice Address - City:MC KENZIE
Practice Address - State:TN
Practice Address - Zip Code:38201-8679
Practice Address - Country:US
Practice Address - Phone:731-986-7200
Practice Address - Fax:731-986-7292
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37119207X00000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN000000353340OtherBCBSKY
KY64082274Medicaid
TN1124048541OtherGROUP NPI
TNP00131527OtherPALMETO GBA
TN2122712OtherFIRST HEALTH
TN4058520OtherBCBSTN
TN3881222Medicaid
TN7469524OtherAETNA
TN1205833142OtherNPI
TN40903919OtherCIGNA
TN143389OtherUNISON
TNP00131527OtherPALMETO GBA
TN3719301Medicare PIN
TN2122712OtherFIRST HEALTH
TN3881222Medicaid
KY64082274Medicaid