Provider Demographics
NPI:1477835866
Name:MELISSA J. MCGINNIS M.D.
Entity Type:Organization
Organization Name:MELISSA J. MCGINNIS M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCGINNIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-886-9701
Mailing Address - Street 1:310 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-2446
Mailing Address - Country:US
Mailing Address - Phone:770-886-9701
Mailing Address - Fax:
Practice Address - Street 1:310 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2446
Practice Address - Country:US
Practice Address - Phone:770-886-9701
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000249257EMedicaid