Provider Demographics
NPI:1720191604
Name:MELVIN, TERRY ANN (MD)
Entity Type:Individual
Prefix:MRS
First Name:TERRY
Middle Name:ANN
Last Name:MELVIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3626 JOHN SIMS RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37412-1810
Mailing Address - Country:US
Mailing Address - Phone:423-802-0028
Mailing Address - Fax:866-493-5813
Practice Address - Street 1:5616 BRAINERD RD
Practice Address - Street 2:SUITE 108
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411-5374
Practice Address - Country:US
Practice Address - Phone:423-803-1379
Practice Address - Fax:866-493-5813
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA035951207RG0300X
TN0000000393251G00000X
TN021452207RG0300X
TN0000000008251G00000X
TN0000000622251G00000X
TN0000000009251G00000X
GA146-207-H251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
E90369Medicare UPIN
E90369Medicare UPIN