Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 64077 | GA |
Y | 207YP0228X | Pediatric Otolaryngology | 64077 | GA |
NPI | 1154522944 |
---|---|
Provider Name | Dr. Melissa Mccarty Statham |
First Address | Alpharetta, GA 30005 |
Second Address | Alpharetta, GA 30005-4429 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2007 |
Last Update Date | 30/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
24777P001 | (02) | GA |
940625142AA | (05) | GA |