MEDICARE: DR. MELISSA J. KULICK PH.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	103T00000X	Psychologist	2335	GA

General Provider Information

NPI Number	:	1871611830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELISSA J. KULICK PH.D.

Provider Business Mailing Address
First Line	:	1945 MASON MILL RD
Second Line	:	#100
City	:	DECATUR
State	:	GA
Zip	:	30033-4006
Country	:	US
Telephone Number	:	404-818-5819
Fax Number	:	404-321-4887

Provider Business Practice Location Address
First Line	:	1945 MASON MILL RD
Second Line	:	#100
City	:	DECATUR
State	:	GA
Zip	:	30033-4006
Country	:	US
Telephone Number	:	404-818-5819
Fax Number	:	404-321-4887

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

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	07/08/2007

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