Healthcare Provider Details

I. General information

NPI: 1861757171
Provider Name (Legal Business Name): MELISSA JONES BUPP APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2012
Last Update Date: 07/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 MOUNT VERNON RD NW
MONROE GA
30655-5028
US

IV. Provider business mailing address

PO BOX 260
MONROE GA
30655-0260
US

V. Phone/Fax

Practice location:
  • Phone: 706-202-7828
  • Fax:
Mailing address:
  • Phone: 706-202-7828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN176757
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: