MEDICARE: MELODY FAKHOURIE LMSW

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	104100000X	Social Worker	MSW012627	GA

General Provider Information

NPI Number	:	1477430122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELODY FAKHOURIE LMSW

Provider Business Mailing Address
First Line	:	21 CEDAR RUN APT C
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30350-2472
Country	:	US
Telephone Number	:	786-600-8341
Fax Number	:

Provider Business Practice Location Address
First Line	:	21 CEDAR RUN APT C
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30350-2472
Country	:	US
Telephone Number	:	786-600-8341
Fax Number	:

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

Provider Enumeration Date	:	08/16/2025
Last Update Date	:	08/16/2025

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