Provider Demographics
NPI:1558458695
Name:MCNAULL, MELISSA ADAMS (MD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ADAMS
Last Name:MCNAULL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2500 N STATE ST
Mailing Address - Street 2:CHILDREN'S CANCER CENTER, UMMC
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-984-5220
Mailing Address - Fax:601-984-5279
Practice Address - Street 1:2500 N STATE ST
Practice Address - Street 2:CHILDREN'S CANCER CENTER, UMMC
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-984-5220
Practice Address - Fax:601-984-5279
Is Sole Proprietor?:No
Enumeration Date:2006-10-09
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS230892080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03521862Medicaid
MS336968YJ5DMedicare PIN