Provider Demographics
NPI:1063751212
Name:KELLER, MEGAN (PA-C)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:KELLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3400 OLD MILTON PKWY # C
Mailing Address - Street 2:SUITE 270
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-3707
Mailing Address - Country:US
Mailing Address - Phone:770-442-1911
Mailing Address - Fax:770-663-8905
Practice Address - Street 1:3400 OLD MILTON PKWY # C
Practice Address - Street 2:SUITE 270
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-3707
Practice Address - Country:US
Practice Address - Phone:770-442-1911
Practice Address - Fax:770-663-8905
Is Sole Proprietor?:No
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA02457363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical