Provider Demographics
NPI:1689916066
Name:ELSON, MELVIN LESLIE (MD)
Entity Type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:LESLIE
Last Name:ELSON
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 1:4081 HIGHWAY 96
Mailing Address - Street 2:
Mailing Address - City:BURNS
Mailing Address - State:TN
Mailing Address - Zip Code:37029-5528
Mailing Address - Country:US
Mailing Address - Phone:615-441-5227
Mailing Address - Fax:615-740-1772
Practice Address - Street 1:4081 HIGHWAY 96
Practice Address - Street 2:
Practice Address - City:BURNS
Practice Address - State:TN
Practice Address - Zip Code:37029-5528
Practice Address - Country:US
Practice Address - Phone:615-441-5227
Practice Address - Fax:615-740-1772
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-23
Last Update Date:2013-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD7061174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist