Provider Demographics
NPI:1659957421
Name:MELENDEZ, EVE LUTRELL (PAC)
Entity Type:Individual
Prefix:
First Name:EVE
Middle Name:LUTRELL
Last Name:MELENDEZ
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:EVE
Other - Middle Name:
Other - Last Name:LUTRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4150 DEPUTY BILL CANTRELL MEMORIAL RD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-3069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4150 DEPUTY BILL CANTRELL MEMORIAL RD
Practice Address - Street 2:SUITE 240
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30044-4827
Practice Address - Country:US
Practice Address - Phone:678-400-0302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10430363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant