Healthcare Provider Details

I. General information

NPI: 1477853174
Provider Name (Legal Business Name): MELSON COUNSELING AND COUNSULTING GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2010
Last Update Date: 10/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 CHAMBLEE TUCKER RD BLDG 5-250
ATLANTA GA
30341-4158
US

IV. Provider business mailing address

2900 CHAMBLEE TUCKER RD 5-250
ATLANTA GA
30341
US

V. Phone/Fax

Practice location:
  • Phone: 770-455-7350
  • Fax:
Mailing address:
  • Phone: 770-455-7350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number004455
License Number StateGA

VIII. Authorized Official

Name: DR. PATRICIA L MELSON
Title or Position: DIRECTOR
Credential:
Phone: 678-938-9841