Provider Demographics
NPI:1619593613
Name:ADAMS, MELISA KAYE (DMD)
Entity Type:Individual
Prefix:DR
First Name:MELISA
Middle Name:KAYE
Last Name:ADAMS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5056 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:JAKIN
Mailing Address - State:GA
Mailing Address - Zip Code:39861-3010
Mailing Address - Country:US
Mailing Address - Phone:229-254-0323
Mailing Address - Fax:
Practice Address - Street 1:11079 COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:BLAKELY
Practice Address - State:GA
Practice Address - Zip Code:39823-3447
Practice Address - Country:US
Practice Address - Phone:229-724-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-25
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN016050122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist