Healthcare Provider Details

I. General information

NPI: 1093635781
Provider Name (Legal Business Name): MELINDA GAIL WHITTON CAC 1
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3543 HIGHWAY 81 # 201
LOGANVILLE GA
30052-4336
US

IV. Provider business mailing address

3543 HIGHWAY 81 # 201
LOGANVILLE GA
30052-4336
US

V. Phone/Fax

Practice location:
  • Phone: 678-615-2382
  • Fax: 770-674-0250
Mailing address:
  • Phone: 678-615-2382
  • Fax: 770-674-0250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: