MEDICARE: MELVA L BANKS FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	RN169120	GA

General Provider Information

NPI Number	:	1083343487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELVA L BANKS FNP-C

Provider Business Mailing Address
First Line	:	1333 CEDAR GROVE RD UNIT 1136
Second Line	:
City	:	CONLEY
State	:	GA
Zip	:	30288-2542
Country	:	US
Telephone Number	:	678-799-1218
Fax Number	:

Provider Business Practice Location Address
First Line	:	4146 JONESBORO RD
Second Line	:
City	:	FOREST PARK
State	:	GA
Zip	:	30297-1038
Country	:	US
Telephone Number	:	470-666-4762
Fax Number	:	770-264-5181

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2022
Last Update Date	:	10/05/2023

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