Healthcare Provider Details

I. General information

NPI: 1447245741
Provider Name (Legal Business Name): MELISSA A ATKINS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 03/26/2021
Certification Date: 03/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 W SOUTH ST
WOODSTOCK VA
22664-1238
US

IV. Provider business mailing address

PO BOX 149
WOODSTOCK VA
22664-0149
US

V. Phone/Fax

Practice location:
  • Phone: 540-459-3753
  • Fax: 540-459-8928
Mailing address:
  • Phone: 540-459-3753
  • Fax: 540-459-8928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number0110001728
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: