Provider Demographics
NPI:1588453377
Name:PERRY, MELVIN
Entity type:Individual
Prefix:
First Name:MELVIN
Middle Name:
Last Name:PERRY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 1/2 E MAIN ST STE C
Mailing Address - Street 2:
Mailing Address - City:HOGANSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30230-1156
Mailing Address - Country:US
Mailing Address - Phone:678-621-4712
Mailing Address - Fax:
Practice Address - Street 1:203 1/2 E MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:HOGANSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30230-1156
Practice Address - Country:US
Practice Address - Phone:678-621-4712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-06
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL347E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker