Healthcare Provider Details

I. General information

NPI: 1639110638
Provider Name (Legal Business Name): MELVIN G PERRY JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3672 MARATHON CIR STE 140
AUSTELL GA
30106-6821
US

IV. Provider business mailing address

PO BOX 1339
MABLETON GA
30126-1005
US

V. Phone/Fax

Practice location:
  • Phone: 470-502-0202
  • Fax: 470-582-9386
Mailing address:
  • Phone: 470-502-0202
  • Fax: 470-582-9386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number022738
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number49276-020
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberM9577
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberO4-30600
License Number StateKS
# 5
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number046470
License Number StateGA
# 6
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number022738
License Number StateLA
# 7
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number2004025527
License Number StateMO
# 8
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number40058
License Number StateTN
# 9
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number435456
License Number StatePA
# 10
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number35.083485
License Number StateOH
# 11
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number01057110A
License Number StateIN
# 12
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number46470
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: