Melenda Jackson Moore, CSFA, CST

Primary specialty

Surgical AssistantTaxonomy code 246ZC0007X

License

202339 Issued in GA

Practice address

55 Atlanta St SE Ste 204
Marietta, GA 30060-1977

Phone

(678) 517-3428

Fax

(770) 485-1534

NPI assigned

Oct 14, 2026

Last updated

Oct 14, 2026By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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

• Olympian Surgical Assistants

  • Surgical Physician Assistant
  • Marietta, GA
  • NPI 1366978991
  NPD (past)

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

{
    "created_epoch": "1791936000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1791936000000",
    "number": "1831094226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2622 MEMORY LN",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301354452",
            "telephone_number": "678-334-4457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 ATLANTA ST SE STE 204",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601977",
            "telephone_number": "678-517-3428",
            "fax_number": "770-485-1534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "MELENDA",
        "middle_name": "JACKSON",
        "credential": "CSFA, CST",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2026-10-14",
        "last_updated": "2026-10-14",
        "certification_date": "2026-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246ZC0007X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Surgical Assistant",
            "state": "GA",
            "license": "202339",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Moore, MAMFT
• Karen A Moore, M.D.
• Kelsey Elizabeth Moore, APRN
• Kevin Perry Moore, LMSW
• Kimberly Lynne Moore, MS, OTRL
• Melora L Moore, LCSW
• Micah Moore
• Raquel Moore, MSW, LCSW
• Ryan Moore, D.C.
• Sara Moore

• Surgical Assistant in Marietta, GA
• Providers in Marietta, GA by specialty
• Surgical Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2026; 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.