Provider Demographics
NPI:1710399217
Name:WHEELER, MELANIE (NP-C)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:WHEELER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:688 WALNUT ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-2677
Mailing Address - Country:US
Mailing Address - Phone:478-742-7566
Mailing Address - Fax:478-743-2804
Practice Address - Street 1:688 WALNUT ST
Practice Address - Street 2:SUITE 200
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-2677
Practice Address - Country:US
Practice Address - Phone:478-742-7566
Practice Address - Fax:478-743-2804
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN0077840363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner