Basic Information
| Provider Information | |||||||||
| NPI: | 1457327454 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MELTON | ||||||||
| FirstName: | HOWARD | ||||||||
| MiddleName: | LANEY | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4 LIVE OAK CT. | ||||||||
| Address2: | |||||||||
| City: | MOULTRIE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 31768 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2299851080 | ||||||||
| FaxNumber: | 2298909743 | ||||||||
| Practice Location | |||||||||
| Address1: | 4 LIVE OAK CT. | ||||||||
| Address2: | |||||||||
| City: | MOULTRIE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 31768 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2299851080 | ||||||||
| FaxNumber: | 2298909743 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 035697 | GA | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 00502521B | 05 | GA | MEDICAID | BM1602300 | 01 | GA | DEA NUMBER | OTHER | 035697 | 01 | GA | STATE LICENSE NUMBER | OTHER |