Provider Demographics
NPI:1043598592
Name:WALL, MELISSA HOPE FELTS
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:HOPE FELTS
Last Name:WALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 SMOKEY LN
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-7957
Mailing Address - Country:US
Mailing Address - Phone:229-326-5489
Mailing Address - Fax:
Practice Address - Street 1:2336 DAWSON RD
Practice Address - Street 2:SUITE 1100
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-2800
Practice Address - Country:US
Practice Address - Phone:229-312-8799
Practice Address - Fax:229-312-8763
Is Sole Proprietor?:No
Enumeration Date:2011-08-02
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP007890235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist