Healthcare Provider Details

I. General information

NPI: 1285072231
Provider Name (Legal Business Name): MELONEY DENISE JOHNSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2013
Last Update Date: 08/20/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

296 MAYWOOD DR
MARTINEZ GA
30907-2272
US

IV. Provider business mailing address

296 MAYWOOD DRIVE OPTIONAL
MARTINEZ GA
30907-2272
US

V. Phone/Fax

Practice location:
  • Phone: 706-877-8042
  • Fax: 706-945-1697
Mailing address:
  • Phone: 706-877-8042
  • Fax: 706-945-1697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN182512
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN182512
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN182512
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code163WC2100X
TaxonomyContinence Care Registered Nurse
License NumberRN182512
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN182512
License Number StateGA
# 6
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN182512
License Number StateGA
# 7
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License NumberRN182512
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: