Provider Demographics
NPI:1801215793
Name:KINNEBREW, MELISSA ANITA (MD, PHD)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANITA
Last Name:KINNEBREW
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:ANITA
Other - Last Name:CABINIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3495 PIEDMONT RD NE BLDG 9 1ST FLOOR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-1736
Mailing Address - Country:US
Mailing Address - Phone:404-365-0966
Mailing Address - Fax:
Practice Address - Street 1:2525 CUMBERLAND PKWY SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-3915
Practice Address - Country:US
Practice Address - Phone:800-611-1811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-08
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA139953207N00000X
390200000X
GA84061207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program