Healthcare Provider Details

I. General information

NPI: 1609102730
Provider Name (Legal Business Name): MELINDA K. MAITLAND M.ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2009
Last Update Date: 04/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 OLD CHARTWELL DR
JOHNS CREEK GA
30022-8511
US

IV. Provider business mailing address

125 OLD CHARTWELL DR
JOHNS CREEK GA
30022-8511
US

V. Phone/Fax

Practice location:
  • Phone: 717-357-1869
  • Fax: 866-358-3496
Mailing address:
  • Phone: 717-357-1869
  • Fax: 866-358-3496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number05044769
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1356881
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number222Q00000X
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: