Healthcare Provider Details

I. General information

NPI: 1386301398
Provider Name (Legal Business Name): MELISSA RICHELLE PENTON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2021
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 DELUXE CIR STE B
THOMASTON GA
30286-3030
US

IV. Provider business mailing address

101 DELUXE CIR STE B
THOMASTON GA
30286-3030
US

V. Phone/Fax

Practice location:
  • Phone: 706-647-7509
  • Fax: 706-647-6624
Mailing address:
  • Phone: 706-647-7509
  • Fax: 706-647-6624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP247914
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: