Provider Demographics
NPI:1457496234
Name:PRIMROSE, MELISSA D (MD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:D
Last Name:PRIMROSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:D
Other - Last Name:PRIMROSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1005 BOULDER DR
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:GA
Mailing Address - Zip Code:31032-6141
Mailing Address - Country:US
Mailing Address - Phone:478-621-2100
Mailing Address - Fax:770-502-2049
Practice Address - Street 1:1005 BOULDER DR
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:GA
Practice Address - Zip Code:31032-6141
Practice Address - Country:US
Practice Address - Phone:478-621-2100
Practice Address - Fax:770-502-2049
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA53516207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003107029CMedicaid
GA202I086104Medicare PIN