Provider Demographics
NPI:1598307324
Name:MELTON, MATTHEW DILLON (NP)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:DILLON
Last Name:MELTON
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 WOODCOCK RD UNIT 2211
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-1089
Mailing Address - Country:US
Mailing Address - Phone:828-429-7056
Mailing Address - Fax:
Practice Address - Street 1:4700 WATERS AVE STE 507
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-6220
Practice Address - Country:US
Practice Address - Phone:912-350-4750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-14
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN291004363LA2100X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC23395OtherSC BOARD OF NURSING - APRN LICENSE
GARN291004OtherGA BOARD OF NURSING - APRN LICENSE