Provider Demographics
NPI:1396203501
Name:MAWDSLEY CHISHOLM, MELISSA (DC)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:
Last Name:MAWDSLEY CHISHOLM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 NORTHCHASE PKWY SE STE 125
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-6415
Mailing Address - Country:US
Mailing Address - Phone:470-249-3422
Mailing Address - Fax:
Practice Address - Street 1:1130 NORTHCHASE PKWY SE STE 125
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-6415
Practice Address - Country:US
Practice Address - Phone:770-664-4288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010127111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor