Provider Demographics
NPI:1487680153
Name:AMOSU, MELINDA O (MD)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:O
Last Name:AMOSU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 JEFFERSON PKWY
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-5823
Mailing Address - Country:US
Mailing Address - Phone:770-304-2220
Mailing Address - Fax:770-304-2622
Practice Address - Street 1:189 JEFFERSON PKWY
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-5823
Practice Address - Country:US
Practice Address - Phone:770-304-2220
Practice Address - Fax:770-304-2622
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA057422208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics