Healthcare Provider Details

I. General information

NPI: 1891200630
Provider Name (Legal Business Name): MELLISSA WARD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2017
Last Update Date: 05/06/2024
Certification Date: 05/06/2024
Deactivation Date: 07/19/2018
Reactivation Date: 06/28/2021

III. Provider practice location address

710 CENTER ST
COLUMBUS GA
31901-1527
US

IV. Provider business mailing address

777 HEMLOCK ST
MACON GA
31201-2102
US

V. Phone/Fax

Practice location:
  • Phone: 706-571-1454
  • Fax:
Mailing address:
  • Phone: 478-633-6272
  • Fax: 478-633-6269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number90846
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number90846
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: