Provider Demographics
NPI:1497220321
Name:LOGOS, MELISSA (CMF)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:LOGOS
Suffix:
Gender:F
Credentials:CMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9138 CARL LEGETT RD STE C
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-6262
Mailing Address - Country:US
Mailing Address - Phone:228-896-3688
Mailing Address - Fax:228-896-3688
Practice Address - Street 1:9138 CARL LEGETT RD STE C
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-6262
Practice Address - Country:US
Practice Address - Phone:228-896-3688
Practice Address - Fax:228-896-3688
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-08
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy FitterGroup - Single Specialty