Provider Demographics
NPI:1871988360
Name:DUBOIS, MELISSA (NP-C)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:DUBOIS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 TOWNE LAKE PKWY STE 410
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-1604
Mailing Address - Country:US
Mailing Address - Phone:770-517-2145
Mailing Address - Fax:770-517-2147
Practice Address - Street 1:900 TOWNE LAKE PKWY STE 410
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-1604
Practice Address - Country:US
Practice Address - Phone:770-517-2145
Practice Address - Fax:770-517-2147
Is Sole Proprietor?:No
Enumeration Date:2015-04-01
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN212024363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003164414BMedicaid
GA003164414AMedicaid
GA003164414AMedicaid