Healthcare Provider Details

I. General information

NPI: 1487935888
Provider Name (Legal Business Name): RACHEL MILNER MELLICK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2011
Last Update Date: 04/01/2021
Certification Date: 04/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3651 WHEELER RD MOB I SUITE 205
AUGUSTA GA
30909-6521
US

IV. Provider business mailing address

4439 PIERWOOD WAY
EVANS GA
30809-4503
US

V. Phone/Fax

Practice location:
  • Phone: 706-651-2369
  • Fax:
Mailing address:
  • Phone: 770-355-5999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number6264
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: