Basic Information
| Provider Information | |||||||||
| NPI: | 1699968206 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GAFFNEY | ||||||||
| FirstName: | MELISSA | ||||||||
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| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1869 | ||||||||
| Address2: | |||||||||
| City: | FLETCHER | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287321869 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286875616 | ||||||||
| FaxNumber: | 8286508076 | ||||||||
| Practice Location | |||||||||
| Address1: | 438 E VANN RD | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | GREENEVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 377437202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4232781650 | ||||||||
| FaxNumber: | 4232781667 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2007 | ||||||||
| LastUpdateDate: | 01/19/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | 675 | TN | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | 213ES0103X | 675 | TN | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery | 213ES0103X | 756 | NC | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
ID Information
| ID | Type | State | Issuer | Description | 4270991 | 01 | TN | BCBST | OTHER | 5909580 | 05 | NC | MEDICAID | DPM675 | 01 | TN | TN MEDICAL LICENSE | OTHER | 1509078 | 05 | TN | MEDICAID |