Provider Demographics
NPI:1588792816
Name:MELLOM, JEFFREY RALPH (OD)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:RALPH
Last Name:MELLOM
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Gender:M
Credentials:OD
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Mailing Address - Street 1:5995 BARFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30328-4411
Mailing Address - Country:US
Mailing Address - Phone:404-256-1507
Mailing Address - Fax:404-256-1981
Practice Address - Street 1:5901A PEACHTREE DUNWOODY RD
Practice Address - Street 2:STE 500
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328
Practice Address - Country:US
Practice Address - Phone:678-781-7373
Practice Address - Fax:678-538-1972
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2015-05-07
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Provider Licenses
StateLicense IDTaxonomies
GA1054152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I417957Medicare Oscar/Certification