Provider Demographics
NPI:1558680124
Name:COONS, MELICIA DIAN (LMT)
Entity Type:Individual
Prefix:MRS
First Name:MELICIA
Middle Name:DIAN
Last Name:COONS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2107 SHERRILL BLVD
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-4619
Mailing Address - Country:US
Mailing Address - Phone:615-663-8579
Mailing Address - Fax:615-563-4550
Practice Address - Street 1:313 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:TN
Practice Address - Zip Code:37190-1144
Practice Address - Country:US
Practice Address - Phone:615-563-4443
Practice Address - Fax:615-563-4550
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-21
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMT0000002474174400000X
TNCTA0000000819174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist