Provider Demographics
NPI:1861641839
Name:PROBST, MELISSA JOY (APRN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:JOY
Last Name:PROBST
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 BELMONT CREST DR SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-9124
Mailing Address - Country:US
Mailing Address - Phone:646-596-6137
Mailing Address - Fax:
Practice Address - Street 1:687 JOHNSON FERRY RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-4628
Practice Address - Country:US
Practice Address - Phone:770-977-9220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-15
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY335696363LF0000X
GA225300363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily