Provider Demographics
NPI:1538406327
Name:ROACH, MEGAN (MA, LAT, ATC)
Entity type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:
Last Name:ROACH
Suffix:
Gender:F
Credentials:MA, LAT, ATC
Other - Prefix:MS
Other - First Name:MEGAN
Other - Middle Name:IVY
Other - Last Name:HAMMONDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LAT, ATC
Mailing Address - Street 1:2099 HEDGEWOOD TRCE
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-2658
Mailing Address - Country:US
Mailing Address - Phone:910-987-0258
Mailing Address - Fax:
Practice Address - Street 1:2288 MAIN ST E
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-3397
Practice Address - Country:US
Practice Address - Phone:770-972-4840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-14
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260019182255A2300X
GAAT0038292255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer