Provider Demographics
NPI:1386655991
Name:ROBITAILLE, MELISSA (DPM)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:
Last Name:ROBITAILLE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 CANAL ST STE 703
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-4291
Mailing Address - Country:US
Mailing Address - Phone:912-988-3323
Mailing Address - Fax:912-988-3612
Practice Address - Street 1:114 CANAL ST STE 703
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-4291
Practice Address - Country:US
Practice Address - Phone:912-988-3323
Practice Address - Fax:912-355-3186
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD000946213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA817532125AMedicaid
GA817532125AMedicaid
GA571157698OtherTAX ID NUMBER
GA817532125AMedicaid
GA817532125AMedicaid
GA571157698OtherTAX ID NUMBER
GA48SCCLMMedicare ID - Type Unspecified