Provider Demographics
NPI:1932263118
Name:GIANNAMORE, MELISSA
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:
Last Name:GIANNAMORE
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 1:3960 SHALLOWFORD RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-5014
Mailing Address - Country:US
Mailing Address - Phone:770-642-4001
Mailing Address - Fax:770-641-1656
Practice Address - Street 1:3960 SHALLOWFORD RD
Practice Address - Street 2:SUITE A
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-5014
Practice Address - Country:US
Practice Address - Phone:770-642-4001
Practice Address - Fax:770-641-1656
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001323152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000648117AMedicaid
GA000648117AMedicaid
GAU36985Medicare UPIN