Provider Demographics
NPI:1598158289
Name:GILES, MELISSA FERGUSON (CFM)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:FERGUSON
Last Name:GILES
Suffix:
Gender:F
Credentials:CFM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1409 PLAZA WEST DR STE D
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-1418
Mailing Address - Country:US
Mailing Address - Phone:336-760-4333
Mailing Address - Fax:336-760-1433
Practice Address - Street 1:1409 PLAZA WEST DR STE D
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1418
Practice Address - Country:US
Practice Address - Phone:336-760-4333
Practice Address - Fax:336-760-1433
Is Sole Proprietor?:No
Enumeration Date:2015-03-05
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC174400000X, 224P00000X, 225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter