Provider Demographics
NPI:1740414705
Name:PORTER, MELISSA LAWHORN (PA-C)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LAWHORN
Last Name:PORTER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14459
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31416-1459
Mailing Address - Country:US
Mailing Address - Phone:912-790-4000
Mailing Address - Fax:912-790-4407
Practice Address - Street 1:230 E DERENNE AVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-6736
Practice Address - Country:US
Practice Address - Phone:912-790-4000
Practice Address - Fax:912-790-4407
Is Sole Proprietor?:No
Enumeration Date:2009-05-06
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005563363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant