Basic Information
| Provider Information | |||||||||
| NPI: | 1134170095 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HEATH | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 648 | ||||||||
| Address2: | |||||||||
| City: | BREWTON | ||||||||
| State: | AL | ||||||||
| PostalCode: | 364270648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2518676071 | ||||||||
| FaxNumber: | 2518675999 | ||||||||
| Practice Location | |||||||||
| Address1: | 1121 BELLEVILLE AVE | ||||||||
| Address2: | |||||||||
| City: | BREWTON | ||||||||
| State: | AL | ||||||||
| PostalCode: | 364261505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2518676071 | ||||||||
| FaxNumber: | 2518675999 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2006 | ||||||||
| LastUpdateDate: | 10/15/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 000027359 | AL | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 009938412 | 05 | AL | MEDICAID |