Individual provider Active NPI

Melissa D Aycox, CNM

  • Advanced Practice Midwife
  • Conyers, GA
National Provider Identifier
1801058458
Registry record updated Sep 12, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Advanced Practice MidwifeTaxonomy code 367A00000X
License
139568 Issued in GA
Practice address
3240 Avalon Blvd
Conyers, GA 30013-6320
Phone
(770) 860-1133
Fax
(770) 860-1599
NPI assigned
Jun 25, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Advanced Practice Midwife 367A00000X 139568 GA Primary

Addresses

Primary practice location

3240 Avalon Blvd
Conyers, GA 30013-6320

Mailing address

3240 Avalon Blvd
Conyers, GA 30013-6320
Phone (770) 860-1133

Other identifiers 1

IdentifierTypeStateIssuer
188306599BMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161103001041 GA Practitioner - Certified Nurse Midwife (CNM) 0749568293 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Midwife

State licenses

LicenseStateTypeSpecialty
139568GAMDAdvanced Practice Midwife

Practice roles

OrganizationSpecialtyStatusNew patients
Greystone OBGYN PC CurrentSince Oct 1, 2016 Accepting new patients

Locations

3240 Avalon Blvd
Conyers, GA 30013
Phone (770) 860-1133

Organizations & group practices 1

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": "1214352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1347408000000",
    "number": "1801058458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3240 AVALON BLVD",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300136320",
            "telephone_number": "770-860-1133",
            "fax_number": "770-860-1599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3240 AVALON BLVD",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300136320",
            "telephone_number": "770-860-1133",
            "fax_number": "770-860-1599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AYCOX",
        "first_name": "MELISSA",
        "middle_name": "D",
        "name_prefix": "Mrs.",
        "credential": "CNM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-25",
        "last_updated": "2012-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "GA",
            "license": "139568",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "188306599B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Conyers, GA

Sources for this page

Verify at the official NPI Registry.