Provider Demographics
NPI:1346387248
Name:CHARLES MELVILLE, PH.D., PC
Entity Type:Organization
Organization Name:CHARLES MELVILLE, PH.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:H
Authorized Official - Last Name:MELVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:404-266-8881
Mailing Address - Street 1:25B LENOX POINTE NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-3172
Mailing Address - Country:US
Mailing Address - Phone:404-266-8881
Mailing Address - Fax:404-266-8687
Practice Address - Street 1:25B LENOX POINTE NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-3172
Practice Address - Country:US
Practice Address - Phone:404-266-8881
Practice Address - Fax:404-266-8687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY000318103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA62TCCGVMedicare ID - Type Unspecified