Provider Demographics
NPI:1245490614
Name:DISCO, MELANIE DIANE
Entity type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:DIANE
Last Name:DISCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5685 BROOKSTONE WALK NW
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-4582
Mailing Address - Country:US
Mailing Address - Phone:404-429-1907
Mailing Address - Fax:
Practice Address - Street 1:1480 ROSWELL RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-3670
Practice Address - Country:US
Practice Address - Phone:770-973-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHI013456390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program