Healthcare Provider Details

I. General information

NPI: 1144213075
Provider Name (Legal Business Name): RICHARD E MELCHER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 11/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1008 ATLANTA HWY
WARRENTON GA
30828-9109
US

IV. Provider business mailing address

PO BOX 371
WRIGHTSVILLE GA
31096-0371
US

V. Phone/Fax

Practice location:
  • Phone: 706-465-3253
  • Fax: 706-465-3256
Mailing address:
  • Phone: 478-864-3448
  • Fax: 478-864-1288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number018526
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: