Provider Demographics
NPI:1205810249
Name:FAIBICHER, MELANIE WHITE (NP)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:WHITE
Last Name:FAIBICHER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:WHITE
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:650 SILVER PEAK CT
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-4025
Mailing Address - Country:US
Mailing Address - Phone:404-333-9222
Mailing Address - Fax:
Practice Address - Street 1:5788 ROSWELL RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-4904
Practice Address - Country:US
Practice Address - Phone:404-935-9110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN130038363L00000X
GARN150038363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA50BBJCMMedicare ID - Type Unspecified
GAP25181Medicare UPIN