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NPI Code Detail

MEDICARE: MRS. MELODY MALANA SEWELL CNP

MEDICARE:  MRS. MELODY MALANA SEWELL  CNP
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
1363LP0808XPsychiatric/Mental Health Nurse PractitionerRN136672GA

General Provider Information

NPI Number : 1861474074
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MELODY MALANA SEWELL CNP
Provider Business Mailing Address
First Line : 4331 THURMON TANNER RD
Second Line :
City : FLOWERY BRANCH
State : GA
Zip : 30542-2829
Country : US
Telephone Number : 678-513-5733
Fax Number : 678-513-5836
Provider Business Practice Location Address
First Line : 4331 THURMON TANNER RD
Second Line :
City : FLOWERY BRANCH
State : GA
Zip : 30542-2829
Country : US
Telephone Number : 678-513-5733
Fax Number : 678-513-5836
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/15/2005
Last Update Date : 08/28/2008

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