Provider Demographics
NPI:1083910418
Name:WHARTON, MELISSA ALLISON
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:ALLISON
Last Name:WHARTON
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 1:12102 TURNBERRY PL
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-4198
Mailing Address - Country:US
Mailing Address - Phone:678-490-1856
Mailing Address - Fax:678-528-9612
Practice Address - Street 1:5755 NORTHPOINT PKWY STE 56
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-1145
Practice Address - Country:US
Practice Address - Phone:678-528-1652
Practice Address - Fax:678-528-9612
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-02
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOT004974174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist