Provider Demographics
NPI:1730116864
Name:HALL, MELISSA BETH (PA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:BETH
Last Name:HALL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5115 NEW PEACHTREE RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CHAMBLEE
Mailing Address - State:GA
Mailing Address - Zip Code:30341-3326
Mailing Address - Country:US
Mailing Address - Phone:678-336-5951
Mailing Address - Fax:678-336-5955
Practice Address - Street 1:5673 PEACHTREE DUNWOODY RD NE
Practice Address - Street 2:SUITE 300
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1731
Practice Address - Country:US
Practice Address - Phone:404-252-6118
Practice Address - Fax:404-252-8016
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA004227363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA97WCHKZMedicare ID - Type Unspecified
GAQ15488Medicare UPIN