Provider Demographics
NPI:1952008856
Name:MELENDEZ GONZALEZ, DESIREE MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:MARIE
Last Name:MELENDEZ GONZALEZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 W WAUGH ST
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-8769
Mailing Address - Country:US
Mailing Address - Phone:706-277-2321
Mailing Address - Fax:706-278-1273
Practice Address - Street 1:1102 W WAUGH ST
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-8769
Practice Address - Country:US
Practice Address - Phone:706-277-2321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-10
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical