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General NPI Number Information
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NPI Number | 1487566782
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Entity Type | Organization
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Legal Business Name | FAERY MEDICAL, LLC
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Dates
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Enumeration Date | 09/21/2026
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Last Update Date | 09/21/2026
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Provider Practice Location Address
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Address Line | 1171 KING MILL RD
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City | MCDONOUGH
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State | GA
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Zip | 30252-6927
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Country | US
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Telephone | 470-615-9709
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Fax | 470-743-1075
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Provider Business Mailing Address
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Address Line | 1171 KING MILL RD
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City | MCDONOUGH
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State | GA
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Zip | 30252-6927
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Country | US
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Telephone | 470-615-9709
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Fax | 470-743-1075
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Authorized Official
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Title or Position | OWNER, PROVIDER
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Name | MELISSA ROTELLA
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Credential | NP
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Telephone | 470-615-9709
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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