Provider Demographics
NPI:1336394915
Name:SMITH, MELANIE WOODALL (MS, CCC-A)
Entity type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:WOODALL
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 DALLAS HWY STE 301
Mailing Address - Street 2:
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-1243
Mailing Address - Country:US
Mailing Address - Phone:770-459-0408
Mailing Address - Fax:770-459-1575
Practice Address - Street 1:705 DALLAS HWY STE 301
Practice Address - Street 2:
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-1243
Practice Address - Country:US
Practice Address - Phone:770-459-0408
Practice Address - Fax:770-459-1575
Is Sole Proprietor?:No
Enumeration Date:2008-11-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003500237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter