MEDICARE: DR. MELODY LAWANDA BRAY-ROSS MD

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	207Q00000X	Family Medicine Physician	ME 91721	FL
2	207Q00000X	Family Medicine Physician	057147	GA

General Provider Information

NPI Number	:	1326020876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELODY LAWANDA BRAY-ROSS MD

Provider Business Mailing Address
First Line	:	3559 SPRING SHLS
Second Line	:
City	:	ELLENWOOD
State	:	GA
Zip	:	30294-4237
Country	:	US
Telephone Number	:	404-241-6032
Fax Number	:

Provider Business Practice Location Address
First Line	:	3559 SPRING SHLS
Second Line	:
City	:	ELLENWOOD
State	:	GA
Zip	:	30294-4237
Country	:	US
Telephone Number	:	404-241-6032
Fax Number	:

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

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	05/17/2009

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