Individual
MELLAYNE R MYERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4660 RIVERSIDE PARK BLVD, MACON, GA 31210-1395
(478) 474-2114
(478) 474-5043
Mailing address
4660 RIVERSIDE PARK BLVD, MACON, GA 31210-1395
(478) 474-2114
(478) 474-5043
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
048447
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000872858A
—
GA
Enumeration date
06/07/2006
Last updated
05/01/2009
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