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General NPI Number Information
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NPI Number | 1669702296
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Entity Type | Organization
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Legal Business Name | MELVIN G PERRY JR MD, LLC
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Dates
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Enumeration Date | 01/04/2010
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Last Update Date | 01/04/2010
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Provider Practice Location Address
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Address Line | 1216 HERITAGE LAKES DR SW
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City | MABLETON
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State | GA
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Zip | 30126-1248
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Country | US
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Telephone | 770-745-3491
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Fax | 770-745-3491
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Provider Business Mailing Address
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Address Line | PO BOX 1339
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City | MABLETON
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State | GA
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Zip | 30126-1005
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Country | US
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Telephone | 770-745-3491
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Fax | 770-745-3491
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Authorized Official
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Title or Position | OWNER
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Name | DR. MELVIN PERRY
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Credential | MD
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Telephone | 770-745-3491
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2080P0204X
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Taxonomy Name | Pediatric Emergency Medicine (Pediatrics) Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 364SP0200X
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Taxonomy Name | Pediatric Clinical Nurse Specialist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 2080P0203X
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Taxonomy Name | Pediatric Critical Care Medicine Physician
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License Number |
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License Number State |
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