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General NPI Number Information
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NPI Number | 1083910418
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Entity Type | Individual
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Provider Name | MRS. MELISSA ALLISON WHARTON
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Gender | Female
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Dates
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Enumeration Date | 02/02/2011
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Last Update Date | 02/02/2011
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Provider Practice Location Address
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Address Line | 5755 NORTHPOINT PKWY STE 56
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City | ALPHARETTA
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State | GA
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Zip | 30022-1145
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Country | US
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Telephone | 678-528-1652
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Fax | 678-528-9612
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Provider Business Mailing Address
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Address Line | 12102 TURNBERRY PL
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City | LITHONIA
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State | GA
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Zip | 30038-4198
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Country | US
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Telephone | 678-490-1856
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Fax | 678-528-9612
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | OT004974
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License Number State | HI
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