=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083822902
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELISSA DORA WILCOX D.C.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/21/2007
-----------------------------------------------------
Last Update Date | 07/05/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6564 HIGHWAY 53 E SUITE 100
-----------------------------------------------------
City | DAWSONVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30534-6806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-265-7339
-----------------------------------------------------
Fax | 706-216-1209
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6564 HWY 53 EAST SUITE 100
-----------------------------------------------------
City | DAWSONVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30534
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-265-7339
-----------------------------------------------------
Fax | 706-216-1209
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CHIR008629
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------