LARRY B. MELLICK MD NPI 1841309804

NPI Information

NPI: 1841309804
Provider Name: LARRY B. MELLICK, MD
Classification: Pediatrics - 2080P0204X
Entity Type: Individual

Specialization: Pediatric Emergency Medicine

PECOS Registration: Yes

Address:
1120 15TH ST
AUGUSTA, GA
ZIP 30912
Phone: (706) 721-4951
Get Directions

Larry B. Mellick, MD is a pediatric emergency medicine pediatrics in Augusta, GA. The provider is a pediatrician who has special qualifications to manage emergencies in infants and children. Larry B. Mellick, MD NPI is 1841309804. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

1120 15TH ST
AUGUSTA, GA
ZIP 30912-004
Phone: (706) 721-4951
Fax: (706) 721-7941

The NPI 1841309804 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 8/30/2006 and was last updated on 3/31/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2080P0204X	Pediatrics	Pediatric Emergency Medicine	042892	GEORGIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	F05134	MEDICARE UPIN
2	000729319A	MEDICAID	GEORGIA
3	G60514	MEDICAID	SOUTH CAROLINA
4	93BDKBS	MEDICARE ID-TYPE UNSPECIFIED	GEORGIA	GA MEDICARE #

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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