Healthcare Provider Details

I. General information

NPI: 1083205397
Provider Name (Legal Business Name): MELANIE BOMPART RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2021
Last Update Date: 01/29/2021
Certification Date: 01/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3421 MIKE PADGETT HWY
AUGUSTA GA
30906-3815
US

IV. Provider business mailing address

475 HICKORY DR
NORTH AUGUSTA SC
29860-9050
US

V. Phone/Fax

Practice location:
  • Phone: 706-432-4800
  • Fax:
Mailing address:
  • Phone: 727-385-1841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN097054
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: