Individual
MELISSA M DAVIDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
4800 OLDE TOWNE PKWY STE 150A, MARIETTA, GA 30068-4357
(770) 509-1025
(770) 509-1884
Mailing address
PO BOX 2968, KENNESAW, GA 30156-9117
(770) 779-0015
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
002192
GA
363AM0700X
Medical Physician Assistant
002192
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100001575
—
GA
05
—
100001575B
—
GA
05
—
100001575C
—
GA
01
—
10038125
AMERIGROUP
GA
01
—
333457
WELLCARE
GA
Enumeration date
05/20/2006
Last updated
02/26/2021
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