Provider Demographics
NPI:1952308371
Name:FISH, MELISSA TERRY (CNM)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:TERRY
Last Name:FISH
Suffix:
Gender:F
Credentials:CNM
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 9027
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31908-9027
Mailing Address - Country:US
Mailing Address - Phone:706-324-4891
Mailing Address - Fax:706-256-2424
Practice Address - Street 1:2300 MANCHESTER EXPY
Practice Address - Street 2:STE B001
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-6808
Practice Address - Country:US
Practice Address - Phone:706-324-4891
Practice Address - Fax:706-576-4958
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN067040367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000480246FMedicaid
GA000480246FMedicaid
GA000480246FMedicaid