Provider Demographics
NPI:1770522930
Name:CRENSHAW, MELISSA DECKER (MD)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:DECKER
Last Name:CRENSHAW
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 1:4750 WATERS AVE STE 311
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-6268
Mailing Address - Country:US
Mailing Address - Phone:912-350-5937
Mailing Address - Fax:912-350-7514
Practice Address - Street 1:4750 WATERS AVE STE 311
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404
Practice Address - Country:US
Practice Address - Phone:912-350-5937
Practice Address - Fax:912-350-7514
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053440207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA294689103AMedicaid
GA294689103BMedicaid
GA294689103CMedicaid
GA624337OtherWELLCARE
GAP00364467OtherRR MEDICARE
GA294689103DMedicaid
SCG53440Medicaid
GA10064303OtherAMERIGROUP
GA404071OtherWELLCARE
GA404071OtherWELLCARE
GA624337OtherWELLCARE