Provider Demographics
NPI:1104155373
Name:MOYER, MEAGAN FINAN (RD, LD)
Entity type:Individual
Prefix:
First Name:MEAGAN
Middle Name:FINAN
Last Name:MOYER
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1365A CLIFTON RD NE
Mailing Address - Street 2:ROOM A3314
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1013
Mailing Address - Country:US
Mailing Address - Phone:404-778-3603
Mailing Address - Fax:
Practice Address - Street 1:674 EMERIL DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-1195
Practice Address - Country:US
Practice Address - Phone:847-269-5253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-16
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA954768133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA954768OtherNATIONAL REGISTRATION
GALD003339OtherSTATE LISCENSE