Provider Demographics
NPI:1447240932
Name:COON, MELANIE B (CNP)
Entity Type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:B
Last Name:COON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1810 MULKEY RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-1151
Mailing Address - Country:US
Mailing Address - Phone:770-819-9262
Mailing Address - Fax:770-819-0597
Practice Address - Street 1:1810 MULKEY RD
Practice Address - Street 2:SUITE 201
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1151
Practice Address - Country:US
Practice Address - Phone:770-819-9262
Practice Address - Fax:770-819-0597
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN159289363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner