Provider Demographics
NPI:1134185770
Name:YOUNG-HARKINS, ME'LISSA R (DO)
Entity type:Individual
Prefix:
First Name:ME'LISSA
Middle Name:R
Last Name:YOUNG-HARKINS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1802 PRESBYTERIAN DR SW
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35603-1807
Mailing Address - Country:US
Mailing Address - Phone:256-301-5405
Mailing Address - Fax:256-306-4609
Practice Address - Street 1:1802 PRESBYTERIAN DR SW
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35603-1807
Practice Address - Country:US
Practice Address - Phone:256-301-5405
Practice Address - Fax:256-306-4609
Is Sole Proprietor?:No
Enumeration Date:2006-04-22
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALD0674207Q00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALG79156Medicare UPIN