Provider Demographics
NPI:1982805776
Name:DEBERRY, MELISSA STEWART (MD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:STEWART
Last Name:DEBERRY
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 1:180 OLD HIGHWAY 431 STE C
Mailing Address - Street 2:
Mailing Address - City:OWENS CROSS ROADS
Mailing Address - State:AL
Mailing Address - Zip Code:35763-9274
Mailing Address - Country:US
Mailing Address - Phone:256-585-3961
Mailing Address - Fax:256-585-3971
Practice Address - Street 1:180 OLD HIGHWAY 431 STE C
Practice Address - Street 2:
Practice Address - City:HAMPTON COVE
Practice Address - State:AL
Practice Address - Zip Code:35763-9274
Practice Address - Country:US
Practice Address - Phone:256-585-3961
Practice Address - Fax:256-585-3971
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL27059207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PENDINGMedicare UPIN
PENDINGMedicare ID - Type UnspecifiedPENDING
ALPENDINGMedicaid