Provider Demographics
NPI:1427231489
Name:CARDELL, MELONI
Entity Type:Individual
Prefix:
First Name:MELONI
Middle Name:
Last Name:CARDELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MELONI
Other - Middle Name:
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3565 AUSTELL RD SW
Mailing Address - Street 2:SUITE 11
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30008-5769
Mailing Address - Country:US
Mailing Address - Phone:770-319-8000
Mailing Address - Fax:
Practice Address - Street 1:3565 AUSTELL RD SW
Practice Address - Street 2:SUITE 11
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30008-5769
Practice Address - Country:US
Practice Address - Phone:770-319-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-13
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0070542251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics