Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2082S0105X | Plastic Hand Surgeon | 38546 | TN |
NPI | 1558373118 |
---|---|
Provider Name | Melissa Lewis Barton |
First Address | Dyersburg, TN 38025-0846 |
Second Address | Dyersburg, TN 38024-2884 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C76523 | (02) |