Provider Demographics
NPI:1639110638
Name:PERRY, MELVIN G JR (MD)
Entity type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:G
Last Name:PERRY
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 1339
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-1005
Mailing Address - Country:US
Mailing Address - Phone:470-502-0202
Mailing Address - Fax:470-582-9386
Practice Address - Street 1:3672 MARATHON CIR STE 140
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-6821
Practice Address - Country:US
Practice Address - Phone:470-502-0202
Practice Address - Fax:470-582-9386
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2024-10-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA022738208000000X, 2080P0203X
WI49276-0202080P0203X
TXM95772080P0203X
KSO4-306002080P0203X
GA0464702080P0203X
MO20040255272080P0203X
TN400582080P0203X
PA4354562080P0203X
OH35.0834852080P0203X
IN01057110A2080P0203X
GA46470208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000910412KMedicaid
LA1492574Medicaid
LA4M542CQ62Medicare PIN