Provider Demographics
NPI:1679690119
Name:MELSON MOCK, MICHELLE (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:MELSON MOCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:MELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 598
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:NC
Mailing Address - Zip Code:28906-0598
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:93 FAMILY CHURCH RD
Practice Address - Street 2:STE B
Practice Address - City:MURPHY
Practice Address - State:NC
Practice Address - Zip Code:28906-8893
Practice Address - Country:US
Practice Address - Phone:828-835-3550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC97014882084P0800X
IL0360877842084P0800X
WI372242084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1243POtherBCBS NC
NC2243276Medicare ID - Type UnspecifiedNC MEDICARE
G26027Medicare UPIN
NC891243PMedicaid