Basic Information
| Provider Information | |||||||||
| NPI: | 1952701724 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OUTLAW | ||||||||
| FirstName: | MELANIE | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1111 GLYNCO PKWY | ||||||||
| Address2: | BLDG 1 STE10 | ||||||||
| City: | BRUNSWICK | ||||||||
| State: | GA | ||||||||
| PostalCode: | 315257921 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9125346485 | ||||||||
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| Practice Location | |||||||||
| Address1: | 903 WARD ST W | ||||||||
| Address2: | SUITE A | ||||||||
| City: | DOUGLAS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 315333517 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9122601191 | ||||||||
| FaxNumber: | 9122601193 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2014 | ||||||||
| LastUpdateDate: | 12/17/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | RN112116 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.