GARY A. MELLICK (NPI# 1780641506) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780641506 |
| Entity Type | Individual |
| Full Name | GARY A. MELLICK |
| Credential | D.O. |
| Practice Address |
309 Medical Center Dr Sw Fort Payne AL 35968-3420 |
| Practice Telephone | 2568450345 |
| Practice Fax Number | 2568450375 |
| Mailing Telephone | 2568450345 |
| Mailing Fax Number | 2568450375 |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2014-05-16 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 174400000X | Specialist | 055142 | GA | Other Service Providers |
| N | 174400000X | Specialist | 34004503 | OH | Other Service Providers |
| Y | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
DO1117 | AL | Allopathic & Osteopathic Physicians |
| N | 2084N0600X |
Psychiatry & Neurology Specialization: Clinical Neurophysiology |
DO1117 | AL | Allopathic & Osteopathic Physicians |
| N | 2084P2900X |
Psychiatry & Neurology Specialization: Pain Medicine |
DO1117 | AL | Allopathic & Osteopathic Physicians |
| N | 2084S0012X |
Psychiatry & Neurology Specialization: Sleep Medicine |
DO1117 | AL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OH | 078521 | 05 |
| Street Address |
309 MEDICAL CENTER DR SW |
| City | FORT PAYNE |
| State | AL |
| Zip Code | 35968-3420 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124229117 | Paul M Gilreath | Psychiatry & Neurology | 309 Medical Center Dr Sw, Fort Payne, AL 35968-3420 | 2007-05-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417382623 | Lori Land Camp | Pharmacist | 101 Cracker Barrel Row, Ft Payne, AL 35968 | 2013-09-06 |
| 1841424959 | Ashley Renee Cole | Emergency Medicine | 590 Medical Center Dr, Fort Payne, AL 35968 | 2009-05-05 |
| 1871758938 | Michael Steven Digby | Dermatology | 1403 Old Water Works Rd Sw, Fort Payne, AL 35968 | 2008-07-28 |
| 1356516611 | Robyn Reesman, O.d.,inc. | Optometrist | 2001 Glenn Blvd. Sw, Fort Payne, AL 35968 | 2008-04-28 |
| 1124219902 | Rebecca Burns Ingram | Occupational Therapist | 2804 Greenhill Blvd Nw Ste 102, Fort Payne, AL 35968 | 2007-08-06 |
| 1467657957 | Palmer Orthopaedic & Sports Medicine, PC | Orthopaedic Surgery | 315 Medical Center Dr. Sw, Fort Payne, AL 35968 | 2007-06-15 |
| 1225171309 | Dekalb County Health Dept Offsite Epsdt | Public Health or Welfare | 2401 Calvin Dr, S.w., Ft. Payne, AL 35968 | 2007-02-15 |
| 1376612648 | American Hospice -- Fort Payne | Hospice Care, Community Based | 103 3rd Street North West, Suite 202, Fort Payne, AL 35968 | 2006-11-08 |
| 1316978588 | Bhc-palmer Orthopaedics and Sports Medicine | Specialist | 315 Medical Park, Fort Payne, AL 35968 | 2006-07-06 |
| 1487694782 | Fort Payne Hospital Corporation | Hospitalist | 200 Medical Center Dr., Fort Payne, AL 35968 | 2006-06-07 |
| Find all providers in zip 35968 | ||||
| Taxonomy Code | 2084N0400X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Neurology |
| A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124229117 | Paul M Gilreath | Psychiatry & Neurology | 309 Medical Center Dr Sw, Fort Payne, AL 35968-3420 | 2007-05-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780109892 | Brain Wave Solution Alabama LLC | Psychiatry & Neurology | 102 Medical Center Dr Ste D, Prattville, AL 36066-7286 | 2017-08-09 |
| 1104211903 | James Rini | Psychiatry & Neurology | 2451 Fillingim St Ste 10-f, Mobile, AL 36617-2238 | 2015-03-30 |
| 1750790838 | Mohammad Junaid Humayun | Psychiatry & Neurology | 1719 6th Avenue South, Birmingham, AL 35294-2547 | 2014-08-04 |
| 1376951145 | Sanath B Kasi Reddy | Psychiatry & Neurology | 2065 E South Blvd Ste 301, Montgomery, AL 36116-2458 | 2014-07-24 |
| 1033531637 | Sykes Neurology PC | Psychiatry & Neurology | 52 Medical Park Dr E Ste 320, Birmingham, AL 35235-3441 | 2014-01-16 |
| 1275961468 | Chandra Gehi, M.d. | Psychiatry & Neurology | 1 Bradford Pl, Anniston, AL 36207-1003 | 2013-10-24 |
| 1053745778 | Bhc-walker Neurology | Psychiatry & Neurology | 3400 Us Highway 78 E, Medical Arts Tower, Suite 311, Jasper, AL 35501-8951 | 2013-08-29 |
| 1922448042 | Eric Jonathan Jenkie | Psychiatry & Neurology | 1120 S Jackson Hwy Ste 201, Sheffield, AL 35660-5770 | 2013-07-03 |
| 1851737746 | Robert P. Kobelja | Psychiatry & Neurology | 1601 Center St Ste 2s, Mobile, AL 36604 | 2013-05-17 |
| 1730524919 | Kasha Elizabeth Benton | Psychiatry & Neurology | 201 Governors Dr Sw Ste 420, Huntsville, AL 35801 | 2013-05-01 |
| Find all providers with the same taxonomy | ||||
| City | FORT PAYNE |
| Zip Code | 35968 |
Please comment or provide details below to improve the information on GARY A. MELLICK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.