Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 33480 | GA |
NPI | 1588770895 |
---|---|
Provider Name | Mrs. Melissa Lee Warner |
First Address | Dawsonville, GA 30534 |
Second Address | Sautee, GA 30571-3500 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2006 |
Last Update Date | 24/03/2015 |