Healthcare Provider Details

I. General information

NPI: 1396294864
Provider Name (Legal Business Name): MELISSA MCLENDON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2016
Last Update Date: 09/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 COURTENAY DR NE
ATLANTA GA
30306-3421
US

IV. Provider business mailing address

690 COURTENAY DR NE
ATLANTA GA
30306-3421
US

V. Phone/Fax

Practice location:
  • Phone: 404-875-4557
  • Fax: 404-875-1394
Mailing address:
  • Phone: 404-875-4557
  • Fax: 404-875-1394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberMSW007535
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: