Provider Demographics
NPI:1013579242
Name:THOMAS, MELISSA ANN (RDN, LD, CLC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:RDN, LD, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 MEDICAL WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-2159
Mailing Address - Country:US
Mailing Address - Phone:770-736-2354
Mailing Address - Fax:
Practice Address - Street 1:1600 MEDICAL WAY STE 100
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-2159
Practice Address - Country:US
Practice Address - Phone:770-736-2354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-09
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA86009986133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered