Provider Demographics
NPI:1659361343
Name:HORAN, MERLENE VANESSA (MD)
Entity Type:Individual
Prefix:DR
First Name:MERLENE
Middle Name:VANESSA
Last Name:HORAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MERLENE
Other - Middle Name:VERNESSA
Other - Last Name:CHRISTOPHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:881 USS JAMES MADISON RD
Mailing Address - Street 2:
Mailing Address - City:KING'S BAY
Mailing Address - State:GA
Mailing Address - Zip Code:31547
Mailing Address - Country:US
Mailing Address - Phone:912-573-1093
Mailing Address - Fax:912-573-2597
Practice Address - Street 1:881 USS JAMES MADISON RD
Practice Address - Street 2:
Practice Address - City:KING'S BAY
Practice Address - State:GA
Practice Address - Zip Code:31547
Practice Address - Country:US
Practice Address - Phone:912-573-8713
Practice Address - Fax:912-573-2597
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01059897A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine