Individual
MELINDA MATHERLY LAVECCHIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
114 CANAL ST STE 503, POOLER, GA 31322
(912) 450-6300
(912) 450-6303
Mailing address
114 CANAL ST STE 503, POOLER, GA 31322-4261
(912) 450-6300
(912) 450-6303
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
008534
GA
Other
Enumeration date
08/18/2017
Last updated
01/08/2020
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