Provider Demographics
NPI:1043519671
Name:SUMMERLIN, MELISSA DAVIS (NP-C)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:DAVIS
Last Name:SUMMERLIN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:ANN
Other - Last Name:SUMMERLIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NA
Mailing Address - Street 1:1240 JESSE JEWELL PKWY SE
Mailing Address - Street 2:STE 500
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3861
Mailing Address - Country:US
Mailing Address - Phone:770-219-8888
Mailing Address - Fax:770-219-8887
Practice Address - Street 1:1240 JESSE JEWELL PKWY SE STE 500
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3861
Practice Address - Country:US
Practice Address - Phone:770-536-9864
Practice Address - Fax:770-297-5023
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN174484363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN174484OtherNURSE PRACTITIONER LICENSE