Healthcare Provider Details

I. General information

NPI: 1649454539
Provider Name (Legal Business Name): MELANIE RAE LIND-AYRES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 12/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 JESSE HILL JUNIOR DRIVE SOUTHEAST
ATLANTA GA
30303
US

IV. Provider business mailing address

1110 CREEKDALE DR
CLARKSTON GA
30021-1023
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-1440
  • Fax: 404-778-1401
Mailing address:
  • Phone: 404-294-0231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number002079
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: