MEDICARE: MELANIE D. SHORTER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	053167	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518915909
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELANIE D. SHORTER M.D.

Provider Business Mailing Address
First Line	:	106 MORAN DRIVE
Second Line	:
City	:	BONAIRE
State	:	GA
Zip	:	31005
Country	:	US
Telephone Number	:	478-988-1282
Fax Number	:	478-988-3120

Provider Business Practice Location Address
First Line	:	106 MORAN DRIVE
Second Line	:
City	:	BONAIRE
State	:	GA
Zip	:	31005
Country	:	US
Telephone Number	:	478-988-1282
Fax Number	:	478-988-3120

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	05/19/2009

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