Provider Demographics
NPI:1023005832
Name:PETERS, MELISSA LEIGH (MD)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:LEIGH
Last Name:PETERS
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:PO BOX 746450
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6450
Mailing Address - Country:US
Mailing Address - Phone:886-401-3057
Mailing Address - Fax:318-868-6430
Practice Address - Street 1:1700 CENTER ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604-3301
Practice Address - Country:US
Practice Address - Phone:251-415-1000
Practice Address - Fax:251-415-1001
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.26029208000000X, 2080P0204X
AL260292080C0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080C0008XAllopathic & Osteopathic PhysiciansPediatricsChild Abuse Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-09841OtherBCBS
AL7647655OtherAETNA
AL515-24090OtherBCBS
AL102257Medicaid
AL1023005832OtherTRICARE SOUTH
AL009964455Medicaid
AL102257Medicaid