Mellick, Larry B.
Mellick, Larry B. is an individual health care provider with primary practice located at 1120 15Th St , Augusta GA 30912-0004. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatric Emergency Medicine, which is considered as his primary health care specialty. Mellick, Larry B. can be contacted via phone (706) 721-4951.Contact Information
Primary practice address
1120 15Th St
Augusta GA 30912-0004
Phone: (706) 721-4951
Fax: (706) 721-7941
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatric Emergency Medicine | 2080P0204X | 042892 | Georgia |
Profile Details
| NPI number | 1841309804 |
|---|---|
| LBN Legal business name | Mellick, Larry B. |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 30th, 2006 |
| Last updated | Mar 31st, 2011 - about 14 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1841309804 | NPPES |
| South Carolina | MEDICAID | G60514 | |
| South Carolina | MEDICAID | 000729319A |
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