Individual
TIMOTHY MELLISH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
793 W STATE ST, COLUMBUS, OH 43222
(614) 234-5180
Mailing address
793 W STATE ST, COLUMBUS, OH 43222-1551
(614) 234-5180
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
003942
OH
Other
Enumeration date
01/13/2014
Last updated
08/03/2018
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