Provider Demographics
NPI:1215934898
Name:WYNN, MELISSA DOVE (MD)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:DOVE
Last Name:WYNN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7120 HODGSON MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-2532
Mailing Address - Country:US
Mailing Address - Phone:912-352-4490
Mailing Address - Fax:912-352-4490
Practice Address - Street 1:7120 HODGSON MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-2532
Practice Address - Country:US
Practice Address - Phone:912-352-4490
Practice Address - Fax:912-354-4845
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2021-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA024468207RI0200X
GA056940207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA937040212AMedicaid
GA44ZCBLTMedicare ID - Type Unspecified
LA1574091Medicaid
LAH57458Medicare UPIN
LA4E107Medicare ID - Type Unspecified