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General NPI Number Information
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NPI Number | 1366736035
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Entity Type | Individual
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Provider Name | MELISSA J PERRIN-HERNANDEZ M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/31/2011
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Last Update Date | 09/05/2019
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Provider Practice Location Address
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Address Line | 211 FAIRVIEW RD
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City | ELLENWOOD
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State | GA
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Zip | 30294-2721
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Country | US
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Telephone | 678-289-6747
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Fax |
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Provider Business Mailing Address
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Address Line | 211 FAIRVIEW RD
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City | ELLENWOOD
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State | GA
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Zip | 30294-2721
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Country | US
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Telephone | 678-289-6747
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Fax |
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD19062
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License Number State | HI
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 268303
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 83975
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License Number State | GA
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