Provider Demographics
NPI:1912199928
Name:CARROLL, MELISSA ANN (RNFA)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:ANN
Last Name:CARROLL
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 BEAR CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MORELAND
Mailing Address - State:GA
Mailing Address - Zip Code:30259-2813
Mailing Address - Country:US
Mailing Address - Phone:770-317-0814
Mailing Address - Fax:
Practice Address - Street 1:190 BEAR CREEK RD
Practice Address - Street 2:
Practice Address - City:MORELAND
Practice Address - State:GA
Practice Address - Zip Code:30259-2813
Practice Address - Country:US
Practice Address - Phone:770-317-0814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-14
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN113659163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant