Provider Demographics
NPI:1598988040
Name:NORWOOD, MELVINA ALEXIS (PHD)
Entity Type:Individual
Prefix:
First Name:MELVINA
Middle Name:ALEXIS
Last Name:NORWOOD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4395 MEADOW VISTA DR
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-7712
Mailing Address - Country:US
Mailing Address - Phone:770-507-6044
Mailing Address - Fax:770-507-5284
Practice Address - Street 1:110 EAGLES WALK
Practice Address - Street 2:STE. 100
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7204
Practice Address - Country:US
Practice Address - Phone:770-507-6044
Practice Address - Fax:770-507-5284
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003038103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA155420049BMedicaid