Provider Demographics
NPI:1114379732
Name:O'BRIEN, MEAGAN KATHLEEN (PA)
Entity type:Individual
Prefix:
First Name:MEAGAN
Middle Name:KATHLEEN
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1364 CLIFTON RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1059
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5673 PEACHTREE DUNWOODY RD STE 500
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-2147
Practice Address - Country:US
Practice Address - Phone:855-366-7989
Practice Address - Fax:404-251-2973
Is Sole Proprietor?:No
Enumeration Date:2016-07-07
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9111223363A00000X
GA9708363A00000X
IN10002724A363A00000X
IL085005839363A00000X
TXPA12878363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant