Provider Demographics
NPI:1053649657
Name:WHITE, MELISSA ANNE (ARNP-BC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANNE
Last Name:WHITE
Suffix:
Gender:F
Credentials:ARNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 CHARLES GILMAN JR AVE STE B
Mailing Address - Street 2:
Mailing Address - City:KINGSLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31548-5662
Mailing Address - Country:US
Mailing Address - Phone:912-729-8942
Mailing Address - Fax:
Practice Address - Street 1:701 CHARLES GILMAN JR AVE STE B
Practice Address - Street 2:
Practice Address - City:KINGSLAND
Practice Address - State:GA
Practice Address - Zip Code:31548
Practice Address - Country:US
Practice Address - Phone:912-729-8942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-20
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9229224363LA2200X
GARN159091363LA2200X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00991580OtherRAILROAD MEDICARE
GA202I503728Medicare PIN