Melvin, William Stacy

Melvin, William Stacy is an individual health care provider with primary practice located at 3 Professional Park Dr Suite 21, Johnson City TN 37604-6529. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Melvin, William Stacy can be contacted via phone (423) 434-6300.

Contact Information

Primary practice address
3 Professional Park Dr Suite 21 Johnson City TN 37604-6529
Phone: (423) 434-6300
Fax: (423) 434-6312
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 009362-1 New York
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 1608 Tennessee

Profile Details

NPI number 1275517054
LBN Legal business name Melvin, William Stacy
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 5th, 2005
Last updated Dec 31st, 2008 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1275517054 NPPES
Tennessee MEDICAID 1507350

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