Provider Demographics
NPI:1699455964
Name:MELI, APPOLINE MATANDA (NP)
Entity type:Individual
Prefix:
First Name:APPOLINE
Middle Name:MATANDA
Last Name:MELI
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2162 REDDY FARM LN
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017-1758
Mailing Address - Country:US
Mailing Address - Phone:240-374-2408
Mailing Address - Fax:
Practice Address - Street 1:1280 DOGWOOD DR SE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-5046
Practice Address - Country:US
Practice Address - Phone:404-994-4662
Practice Address - Fax:404-994-4663
Is Sole Proprietor?:No
Enumeration Date:2023-07-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA234934363LP2300X
GARN234934363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care