Provider Demographics
NPI:1528224649
Name:WEEKS, MARY MELISSA (CNA)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:MELISSA
Last Name:WEEKS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:LUTHERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30251-1705
Mailing Address - Country:US
Mailing Address - Phone:770-927-2546
Mailing Address - Fax:
Practice Address - Street 1:165 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:LUTHERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30251-1705
Practice Address - Country:US
Practice Address - Phone:770-927-2546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0028865538374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide