Healthcare Provider Details

I. General information

NPI: 1861462970
Provider Name (Legal Business Name): MELANIE MOONEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 06/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 S COLUMBIA AVE
RINCON GA
31326
US

IV. Provider business mailing address

602 E 72ND ST
SAVANNAH GA
31405-4913
US

V. Phone/Fax

Practice location:
  • Phone: 912-826-8860
  • Fax: 912-826-2813
Mailing address:
  • Phone: 912-819-7878
  • Fax: 912-819-7850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number39861
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: