Provider Demographics
NPI:1962876128
Name:JADICK, MELISSA (DO)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:JADICK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 TROTTERS RDG
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30215-6540
Mailing Address - Country:US
Mailing Address - Phone:803-215-7395
Mailing Address - Fax:
Practice Address - Street 1:135 TROTTERS RDG
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30215-6540
Practice Address - Country:US
Practice Address - Phone:803-215-7395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-25
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA056877208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics