Provider Demographics
NPI:1922042118
Name:MARTIN, MELISSA (CPNP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5461 MERIDIAN MARK RD STE 400
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-3283
Mailing Address - Country:US
Mailing Address - Phone:404-785-1112
Mailing Address - Fax:404-785-3600
Practice Address - Street 1:5461 MERIDIAN MARK RD STE 400
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-3283
Practice Address - Country:US
Practice Address - Phone:404-785-1112
Practice Address - Fax:404-785-3600
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN167333363L00000X, 207RH0003X
GA1922042118363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology