Healthcare Provider Details

I. General information

NPI: 1114774494
Provider Name (Legal Business Name): MELISSA DEL TUFO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2024
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 15TH ST
AUGUSTA GA
30912-0006
US

IV. Provider business mailing address

1120 15TH ST
AUGUSTA GA
30912-0006
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-3186
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number16507
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: