Provider Demographics
NPI:1700800752
Name:BABCOCK, MELISSA (MD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:
Last Name:BABCOCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4890 ROSWELL RD
Mailing Address - Street 2:SUITE B-10
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-2606
Mailing Address - Country:US
Mailing Address - Phone:404-835-3052
Mailing Address - Fax:404-835-3053
Practice Address - Street 1:4890 ROSWELL RD
Practice Address - Street 2:SUITE B-10
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-2606
Practice Address - Country:US
Practice Address - Phone:404-835-3052
Practice Address - Fax:404-835-3053
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA059368207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery