Provider Demographics
NPI:1124367719
Name:MOTLEY, MELINDA DAWN
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:DAWN
Last Name:MOTLEY
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 1:575 MOSSY TRCE
Mailing Address - Street 2:
Mailing Address - City:WINDER
Mailing Address - State:GA
Mailing Address - Zip Code:30680-8523
Mailing Address - Country:US
Mailing Address - Phone:678-425-9904
Mailing Address - Fax:
Practice Address - Street 1:575 MOSSY TRCE
Practice Address - Street 2:
Practice Address - City:WINDER
Practice Address - State:GA
Practice Address - Zip Code:30680-8523
Practice Address - Country:US
Practice Address - Phone:678-425-9904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-03
Last Update Date:2013-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator