Provider Demographics
NPI:1053308890
Name:LIMONTA, MELISSA D (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:D
Last Name:LIMONTA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MRS
Other - First Name:MELISSA
Other - Middle Name:DIANA
Other - Last Name:RUSSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:4514 HEATHROW CT NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-7750
Mailing Address - Country:US
Mailing Address - Phone:404-642-4335
Mailing Address - Fax:770-645-8455
Practice Address - Street 1:780 CANTON ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-7259
Practice Address - Country:US
Practice Address - Phone:678-574-0943
Practice Address - Fax:678-574-0943
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN143177367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA366255330AMedicaid
GA511I4301885Medicare PIN
GA43ZCBXF30Medicare PIN