Individual
MISS FAYE JEAN MELLARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT, NMT
Contact information
Practice address
237 SCENIC HWY, LAWRENCEVILLE, GA 30046-5621
(404) 731-1735
Mailing address
158 PAPER MILL RD APT 4103, LAWRENCEVILLE, GA 30046-5345
(404) 645-1263
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
—
GA
225700000X
Massage Therapist
Primary
MT004030
GA
Other
Enumeration date
01/17/2018
Last updated
01/17/2018
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