Provider Demographics
NPI:1326020876
Name:BRAY-ROSS, MELODY LAWANDA (MD)
Entity Type:Individual
Prefix:DR
First Name:MELODY
Middle Name:LAWANDA
Last Name:BRAY-ROSS
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 1:3559 SPRING SHLS
Mailing Address - Street 2:
Mailing Address - City:ELLENWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30294-4237
Mailing Address - Country:US
Mailing Address - Phone:404-241-6032
Mailing Address - Fax:
Practice Address - Street 1:3559 SPRING SHLS
Practice Address - Street 2:
Practice Address - City:ELLENWOOD
Practice Address - State:GA
Practice Address - Zip Code:30294-4237
Practice Address - Country:US
Practice Address - Phone:404-241-6032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2009-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 91721207Q00000X
GA057147207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine