Provider Demographics
NPI:1225321201
Name:MELSON, GRACE ANN (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:ANN
Last Name:MELSON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2353 WALNUT TREE LN
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-2253
Mailing Address - Country:US
Mailing Address - Phone:205-382-5025
Mailing Address - Fax:
Practice Address - Street 1:555 SUN VALLEY DR
Practice Address - Street 2:BUILDING D
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-5612
Practice Address - Country:US
Practice Address - Phone:678-990-5401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-24
Last Update Date:2013-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-109860363L00000X
GARN213069363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner