Provider Demographics
NPI:1629142781
Name:SCARBORO, MELISSA R (CFOM)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:R
Last Name:SCARBORO
Suffix:
Gender:F
Credentials:CFOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 REMINGTON CT
Mailing Address - Street 2:
Mailing Address - City:BYRON
Mailing Address - State:GA
Mailing Address - Zip Code:31008-8614
Mailing Address - Country:US
Mailing Address - Phone:478-953-2922
Mailing Address - Fax:
Practice Address - Street 1:110 OSIGIAN BLVD
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-7880
Practice Address - Country:US
Practice Address - Phone:478-953-2922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACFOM0269OtherABC CERTIFIED FITTER