Provider Demographics
NPI:1780894188
Name:MELTON, JEFFREY ALLEN
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ALLEN
Last Name:MELTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 HERMITAGE DR
Mailing Address - Street 2:P.O. BOX 2173
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37745-6510
Mailing Address - Country:US
Mailing Address - Phone:423-638-6060
Mailing Address - Fax:
Practice Address - Street 1:GREENE VALLEY DEVELOPMENTAL CENTER
Practice Address - Street 2:4850 EAST ANDREW JOHNSON HWY
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37743
Practice Address - Country:US
Practice Address - Phone:423-787-6726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2091225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant