MEDICARE: MARYELLEN MCMELLION

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	367500000X	Certified Registered Nurse Anesthetist	ARNP9322064	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9322064	OTHER	FL	ARNP LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669776415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARYELLEN MCMELLION

Provider Business Mailing Address
First Line	:	3228 QUINCEY XING
Second Line	:
City	:	CONYERS
State	:	GA
Zip	:	30013-6385
Country	:	US
Telephone Number	:	404-358-4354
Fax Number	:

Provider Business Practice Location Address
First Line	:	7111 FAIRWAY DR
Second Line	:	SUITE 450
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33418-4204
Country	:	US
Telephone Number	:	561-623-2021
Fax Number	:

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

Provider Enumeration Date	:	01/07/2011
Last Update Date	:	05/13/2024

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