Provider Demographics
NPI:1578871885
Name:STROUD, MELISSA F (RN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:F
Last Name:STROUD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3889 COBB PKWY NW
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-4084
Mailing Address - Country:US
Mailing Address - Phone:770-975-1299
Mailing Address - Fax:
Practice Address - Street 1:3889 COBB PKWY NW
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-4084
Practice Address - Country:US
Practice Address - Phone:770-975-1299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-21
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN145301163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN145301OtherRN LICENSE #
GA202I508218Medicare PIN