MEDICARE: MRS. MELISSA JONES BUPP APRN

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	363LW0102X	Women's Health Nurse Practitioner	RN176757	GA

General Provider Information

NPI Number	:	1861757171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELISSA JONES BUPP APRN

Provider Business Mailing Address
First Line	:	PO BOX 260
Second Line	:
City	:	MONROE
State	:	GA
Zip	:	30655-0260
Country	:	US
Telephone Number	:	706-202-7828
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 MOUNT VERNON RD NW
Second Line	:
City	:	MONROE
State	:	GA
Zip	:	30655-5028
Country	:	US
Telephone Number	:	706-202-7828
Fax Number	:

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

Provider Enumeration Date	:	07/12/2012
Last Update Date	:	07/12/2012

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