Individual provider Active NPI

Melissa Mawdsley Chisholm, DC

  • Chiropractor
  • Marietta, GA
National Provider Identifier
1396203501
Registry record updated Mar 6, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CHIR010127 Issued in GA
Practice address
1130 Northchase Pkwy SE Ste 125
Marietta, GA 30067-6415
Phone
(770) 664-4288
NPI assigned
Mar 6, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 6, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X CHIR010127 GA Primary

Addresses

Primary practice location

1130 Northchase Pkwy SE Ste 125
Marietta, GA 30067-6415

Mailing address

1130 Northchase Pkwy SE Ste 125
Marietta, GA 30067-6415
Phone (470) 249-3422

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CHIR010127GAMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Georgia Chiropractic Neurology Center LLC CurrentSince Mar 20, 2019 Accepting new patients
Choose Life Inc Past Accepting new patients

Locations

903 Bombay Ln
Roswell, GA 30076
Phone (770) 664-4288

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1551830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551830400000",
    "number": "1396203501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1130 NORTHCHASE PKWY SE STE 125",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300676415",
            "telephone_number": "470-249-3422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1130 NORTHCHASE PKWY SE STE 125",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300676415",
            "telephone_number": "770-664-4288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAWDSLEY CHISHOLM",
        "first_name": "MELISSA",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-06",
        "last_updated": "2019-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "GA",
            "license": "CHIR010127",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.