Provider Demographics
NPI:1649454539
Name:LIND-AYRES, MELANIE RAE (MD)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:RAE
Last Name:LIND-AYRES
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1110 CREEKDALE DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:GA
Mailing Address - Zip Code:30021-1023
Mailing Address - Country:US
Mailing Address - Phone:404-294-0231
Mailing Address - Fax:
Practice Address - Street 1:33 JESSE HILL JUNIOR DRIVE SOUTHEAST
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303
Practice Address - Country:US
Practice Address - Phone:404-778-1440
Practice Address - Fax:404-778-1401
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA002079208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA002079OtherRESIDENCY TRAINING PERMIT