Provider Demographics
NPI:1952613382
Name:WILLMAN, MELISSA CLARE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:CLARE
Last Name:WILLMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:MELISSA
Other - Middle Name:CLARE
Other - Last Name:ZACHMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:4800 OLDE TOWNE PKWY STE 420
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-4424
Mailing Address - Country:US
Mailing Address - Phone:404-256-2535
Mailing Address - Fax:404-845-4720
Practice Address - Street 1:4800 OLDE TOWNE PKWY STE 420
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-4424
Practice Address - Country:US
Practice Address - Phone:404-256-2535
Practice Address - Fax:404-845-4720
Is Sole Proprietor?:No
Enumeration Date:2010-07-14
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001002388363AM0700X
GA008211363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8102465Medicaid
NC8102465Medicaid