Provider Demographics
NPI:1851602569
Name:HALL, MELANIE KEENE (MD)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:KEENE
Last Name:HALL
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 1:415 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7246
Mailing Address - Country:US
Mailing Address - Phone:601-268-0929
Mailing Address - Fax:601-579-5240
Practice Address - Street 1:15 ORLEANS DR
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-8675
Practice Address - Country:US
Practice Address - Phone:601-579-5050
Practice Address - Fax:601-296-6872
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS22468207Q00000X
MSPENDING390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS4148659OtherAETNA
MS5481296OtherCIGNA
MS03057378Medicaid
MSP01243908OtherRAILROAD MEDICARE
MS6116068OtherHEALTHSPRING
MS3631580OtherUNITED HEALTHCARE
MS5481296OtherCIGNA