Basic Information
| Provider Information | |||||||||
| NPI: | 1487756508 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LERAY | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | AA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 610 TREYBURN MANOR DR | ||||||||
| Address2: | |||||||||
| City: | MILTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300043084 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4044041413 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6325 HOSPITAL PKWY | ||||||||
| Address2: | |||||||||
| City: | JOHNS CREEK | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300975775 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047788311 | ||||||||
| FaxNumber: | 7704951585 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2006 | ||||||||
| LastUpdateDate: | 03/10/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367H00000X | Y | Physician Assistants & Advanced Practice Nursing Providers | Anesthesiologist Assistant |
No ID Information.