Provider Demographics
NPI:1467494591
Name:LIGHTFORD, MELVIN W (MD)
Entity Type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:W
Last Name:LIGHTFORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3024 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:615-239-2018
Mailing Address - Fax:
Practice Address - Street 1:131 FRENCH LANDING DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37228-1511
Practice Address - Country:US
Practice Address - Phone:615-254-9981
Practice Address - Fax:615-254-9747
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15942207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3057012OtherBLUECROSS BLUESHIELD
TN3836277Medicaid
TN4316318OtherAETNA
TN3836277Medicaid
TNP00944302Medicare PIN
TNA98156Medicare UPIN
TN3836277Medicare PIN