Healthcare Provider Details

I. General information

NPI: 1174249874
Provider Name (Legal Business Name): MELANIE HACKNEY PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2022
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 COGGINS PL NE
MARIETTA GA
30060-2585
US

IV. Provider business mailing address

1314 CONCORD RD SE
SMYRNA GA
30080-4361
US

V. Phone/Fax

Practice location:
  • Phone: 770-422-2009
  • Fax: 770-428-0330
Mailing address:
  • Phone: 770-438-1799
  • Fax: 770-825-9046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN284708
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: