Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 9267972 | FL |
NPI | 1003125410 |
---|---|
Provider Name | Mrs. Melanie Jai Balfour |
First Address | Thomasville, GA 31792-5473 |
Second Address | Thomasville, GA 31792-5473 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2010 |
Last Update Date | 01/04/2021 |