1306142609 NPI number — MELISSA A. MUNNA APRN

Table of content: MELISSA A. MUNNA APRN (NPI 1306142609)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306142609 NPI number — MELISSA A. MUNNA APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MUNNA
Provider First Name:
MELISSA
Provider Middle Name:
A.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306142609
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5263 DEERING TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARIETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30068-1711
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-665-8570
Provider Business Mailing Address Fax Number:
678-205-9005

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11975 MORRIS RD STE 140
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALPHARETTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30005-4444
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-665-8570
Provider Business Practice Location Address Fax Number:
678-205-9005
Provider Enumeration Date:
02/03/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  00015172 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)