Provider Demographics
NPI:1093281248
Name:SUTTON, MELISSA A (NP-C)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:SUTTON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:YORK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:83 BRUTIS DR
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRING
Mailing Address - State:GA
Mailing Address - Zip Code:30739-4076
Mailing Address - Country:US
Mailing Address - Phone:706-271-7253
Mailing Address - Fax:
Practice Address - Street 1:14160 HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:TRION
Practice Address - State:GA
Practice Address - Zip Code:30753-1530
Practice Address - Country:US
Practice Address - Phone:706-696-0555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-15
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN157606363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000211956CMedicaid