Provider Demographics
NPI:1538732797
Name:GRIFFITH, MELANIE D
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:D
Last Name:GRIFFITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 DOWELL SPRINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-2454
Mailing Address - Country:US
Mailing Address - Phone:865-588-5121
Mailing Address - Fax:
Practice Address - Street 1:1311 DOWELL SPRINGS BLVD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-2454
Practice Address - Country:US
Practice Address - Phone:865-588-5121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-23
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN149310363L00000X
TN29904363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner