Provider Demographics
NPI:1154097764
Name:CHILDS, MEGAN JASMINE (CAA)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:JASMINE
Last Name:CHILDS
Suffix:
Gender:F
Credentials:CAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 SILVER MIST CIR
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-6067
Mailing Address - Country:US
Mailing Address - Phone:704-654-0430
Mailing Address - Fax:
Practice Address - Street 1:57 EXECUTIVE PARK S STE 800
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2288
Practice Address - Country:US
Practice Address - Phone:404-727-5910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-23
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA11794367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program