Provider Demographics
NPI:1043242894
Name:COLLUM, MELANIE D (FNP-BC)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:D
Last Name:COLLUM
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:391 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:JESUP
Mailing Address - State:GA
Mailing Address - Zip Code:31545-1132
Mailing Address - Country:US
Mailing Address - Phone:912-427-8433
Mailing Address - Fax:912-427-9851
Practice Address - Street 1:391 S 1ST ST
Practice Address - Street 2:
Practice Address - City:JESUP
Practice Address - State:GA
Practice Address - Zip Code:31545-1132
Practice Address - Country:US
Practice Address - Phone:912-427-8433
Practice Address - Fax:912-427-9851
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN057165363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA50BBJZGOtherMEDICARE PROVIDER NUMBER
GA50BBJZGOtherMEDICARE PROVIDER NUMBER