Provider Demographics
NPI:1154522944
Name:STATHAM, MELISSA MCCARTY (MD)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:MCCARTY
Last Name:STATHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3400-C OLD MILTON PARKWAY
Mailing Address - Street 2:SUITE 465
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005
Mailing Address - Country:US
Mailing Address - Phone:770-777-1100
Mailing Address - Fax:770-751-9089
Practice Address - Street 1:3400 OLD MILTON PKWY STE C465
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4429
Practice Address - Country:US
Practice Address - Phone:770-777-1100
Practice Address - Fax:770-751-9089
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA64077207Y00000X, 207YP0228X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA940625142AAMedicaid
GA202I041590Medicare PIN
GA24777P001Medicare UPIN