Provider Demographics
NPI:1114441458
Name:THOMAS, MELODY ELAINE (NP)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:ELAINE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:853 N CHURCH ST STE 620
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3070
Practice Address - Country:US
Practice Address - Phone:864-573-7511
Practice Address - Fax:864-560-1690
Is Sole Proprietor?:No
Enumeration Date:2017-07-28
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC219744163W00000X
SC21222363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSCB1966067OtherMEDICARE PIN
SCSCB1966121OtherMEDICARE PIN
SCNP4651Medicaid
SCSCB1965206OtherMEDICARE PIN