Provider Demographics
NPI:1073572707
Name:MCGINNIS, MELISSA JUNE (MD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:JUNE
Last Name:MCGINNIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040
Mailing Address - Country:US
Mailing Address - Phone:770-886-9701
Mailing Address - Fax:770-886-3302
Practice Address - Street 1:310 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040
Practice Address - Country:US
Practice Address - Phone:770-886-9701
Practice Address - Fax:770-886-3302
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA024022208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00249257EMedicaid
GA1200172OtherUNITED HEALTHCARE
GA4084285OtherAETNA
GA1200172OtherUNITED HEALTHCARE