Provider Demographics
NPI:1013120815
Name:PHILLIPS, MELISSA SUSAN (MD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:SUSAN
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:PHILLIPS
Other - Last Name:LAPINSKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1934 ALCOA HWY STE D285
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920
Mailing Address - Country:US
Mailing Address - Phone:865-305-9620
Mailing Address - Fax:865-525-3460
Practice Address - Street 1:1934 ALCOA HWY STE D285
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920
Practice Address - Country:US
Practice Address - Phone:865-305-9620
Practice Address - Fax:865-525-3460
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD47588208600000X
VA0116017624390200000X
390200000X
TNMD0000047588208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1525023Medicaid
TN1525023Medicaid