Basic Information
| Provider Information | |||||||||
| NPI: | 1467727230 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MELANGE HEALTH SOLUTIONS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 145 SCALEYBARK RD STE B | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282092682 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7045678690 | ||||||||
| FaxNumber: | 7045366030 | ||||||||
| Practice Location | |||||||||
| Address1: | 3188 ATLANTA RD SE | ||||||||
| Address2: | |||||||||
| City: | SMYRNA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300808256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7703196000 | ||||||||
| FaxNumber: | 7703196330 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/13/2012 | ||||||||
| LastUpdateDate: | 03/13/2012 | ||||||||
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| AuthorizedOfficialLastName: | HAWKINS | ||||||||
| AuthorizedOfficialFirstName: | GARDNER | ||||||||
| AuthorizedOfficialMiddleName: | LORENZO | ||||||||
| AuthorizedOfficialTitleorPosition: | PRINCIPAL | ||||||||
| AuthorizedOfficialTelephone: | 7045678690 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | N | Agencies | Case Management | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.