Provider Demographics
NPI:1336142363
Name:REYNOLDS, MELISSA G (MD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:G
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3024 BUSINESS PARK CIR
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3132
Mailing Address - Country:US
Mailing Address - Phone:615-851-6033
Mailing Address - Fax:615-851-2018
Practice Address - Street 1:330 23RD AVE N
Practice Address - Street 2:SUITE 604
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1534
Practice Address - Country:US
Practice Address - Phone:615-329-7940
Practice Address - Fax:615-284-7044
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2023-02-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN27902207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6078023OtherBLUE CROSS BLUE SHIELD
TNG30153Medicare UPIN
TN103I165360Medicare PIN