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General NPI Number Information
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NPI Number | 1487943734
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Entity Type | Individual
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Provider Name | MELISSA MOONEY WIKOFF AU.D
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Gender | Female
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Dates
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Enumeration Date | 04/06/2011
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Last Update Date | 05/13/2016
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Provider Practice Location Address
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Address Line | 280 OLD COLLEGE WAY
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City | ATLANTA
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State | GA
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Zip | 30328-1046
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Country | US
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Telephone | 470-485-4327
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 73051
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City | MARIETTA
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State | GA
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Zip | 30007-3051
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Country | US
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Telephone | 470-485-4327
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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 | 231H00000X
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Taxonomy Name | Audiologist
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License Number | AU2750
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | AUD003887
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License Number State | GA
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