Individual
DR. MELANIA B. DOMINGO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
510 MAPLE DR, VIDALIA, GA 30474-8912
(912) 537-9334
(912) 537-0019
Mailing address
510 MAPLE DR, VIDALIA, GA 30474-8912
(912) 537-9334
(912) 537-0019
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
017919
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000014671A
—
GA
Enumeration date
04/04/2006
Last updated
02/14/2019
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