Provider Demographics
NPI:1013927946
Name:MELISSA JADICK
Entity Type:Organization
Organization Name:MELISSA JADICK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-854-2558
Mailing Address - Street 1:1303 DANTIGNAC ST
Mailing Address - Street 2:SUITE 2600
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-2775
Mailing Address - Country:US
Mailing Address - Phone:706-854-2500
Mailing Address - Fax:706-774-7209
Practice Address - Street 1:1303 DANTIGNAC ST
Practice Address - Street 2:SUITE 2600
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-2775
Practice Address - Country:US
Practice Address - Phone:706-854-2500
Practice Address - Fax:706-774-7209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA056877208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty