Provider Demographics
NPI:1467145011
Name:MELVANEEDS CARE SERVICES
Entity Type:Organization
Organization Name:MELVANEEDS CARE SERVICES
Other - Org Name:MELVA-NEEDS CARE SERVICES, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELVANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MELTON-SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, FNP
Authorized Official - Phone:229-239-9677
Mailing Address - Street 1:162 OCILLA HWY STE 14
Mailing Address - Street 2:
Mailing Address - City:FITZGERALD
Mailing Address - State:GA
Mailing Address - Zip Code:31750-3795
Mailing Address - Country:US
Mailing Address - Phone:229-239-9677
Mailing Address - Fax:
Practice Address - Street 1:162 OCILLA HWY STE 14
Practice Address - Street 2:
Practice Address - City:FITZGERALD
Practice Address - State:GA
Practice Address - Zip Code:31750-3795
Practice Address - Country:US
Practice Address - Phone:229-239-9677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-31
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty