Healthcare Provider Details

I. General information

NPI: 1497168363
Provider Name (Legal Business Name): ALLISON MELONI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2014
Last Update Date: 11/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1557 JANMAR RD
SNELLVILLE GA
30078-5686
US

IV. Provider business mailing address

1305 FAIRCREST LN
ALPHARETTA GA
30004-0582
US

V. Phone/Fax

Practice location:
  • Phone: 678-344-8900
  • Fax:
Mailing address:
  • Phone: 724-825-1696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number007198
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number7198
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: