Provider Demographics
NPI:1205988078
Name:WHITE, MELINDA SHEA (AUDFAAA,CCC-A)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:SHEA
Last Name:WHITE
Suffix:
Gender:F
Credentials:AUDFAAA,CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1719 RUSSELL PKWY, BLDG
Mailing Address - Street 2:CENTRAL GA PROFESSIONAL HEARING
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088
Mailing Address - Country:US
Mailing Address - Phone:478-923-0106
Mailing Address - Fax:478-922-5211
Practice Address - Street 1:1719 RUSSELL PKWY, BLDG
Practice Address - Street 2:CENTRAL GA PROFESSIONAL HEARING
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088
Practice Address - Country:US
Practice Address - Phone:478-923-0106
Practice Address - Fax:478-922-5211
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD003181231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP24Medicare ID - Type UnspecifiedGROUP MCARE PROV #
GA64PCBGFMedicare ID - Type UnspecifiedINDIVIDUAL MCARE PROV #