Provider Demographics
NPI:1134170095
Name:HEATH, MELISSA LYNN (MD)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:LYNN
Last Name:HEATH
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 648
Mailing Address - Street 2:
Mailing Address - City:BREWTON
Mailing Address - State:AL
Mailing Address - Zip Code:36427-0648
Mailing Address - Country:US
Mailing Address - Phone:251-867-6071
Mailing Address - Fax:251-867-5999
Practice Address - Street 1:1121 BELLEVILLE AVE
Practice Address - Street 2:
Practice Address - City:BREWTON
Practice Address - State:AL
Practice Address - Zip Code:36426-1505
Practice Address - Country:US
Practice Address - Phone:251-867-6071
Practice Address - Fax:251-867-5999
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL000027359207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009938412Medicaid
ALI56062Medicare UPIN