Provider Demographics
NPI:1427506948
Name:MAINOR, MESHA
Entity type:Individual
Prefix:
First Name:MESHA
Middle Name:
Last Name:MAINOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 720093
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30358-2093
Mailing Address - Country:US
Mailing Address - Phone:404-428-6197
Mailing Address - Fax:
Practice Address - Street 1:4586 TIMBER RIDGE DR
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-7517
Practice Address - Country:US
Practice Address - Phone:404-428-6197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-13
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist