Provider Demographics
NPI:1346233913
Name:WOODALL, MELANIE L (MD)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:L
Last Name:WOODALL
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 405827
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-5800
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7685 WINCHESTER RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-2202
Practice Address - Country:US
Practice Address - Phone:901-752-6963
Practice Address - Fax:901-751-5540
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNM017431207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4131555OtherAETNA
TN2668204OtherCIGNA
TN111679OtherBCBS, TN
TN140373OtherUNITED HEALTHCARE
TN111679OtherBCBS, TN
TN080037708Medicare PIN
A99363Medicare UPIN