Provider Demographics
NPI:1841439387
Name:WALPOLE, MEGAN W (PAC)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:W
Last Name:WALPOLE
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
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Mailing Address - Street 1:131 CREEKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-1766
Mailing Address - Country:US
Mailing Address - Phone:404-680-0415
Mailing Address - Fax:
Practice Address - Street 1:6325 SHANNON PKWY
Practice Address - Street 2:SUITE D
Practice Address - City:UNION CITY
Practice Address - State:GA
Practice Address - Zip Code:30291-1538
Practice Address - Country:US
Practice Address - Phone:770-964-1400
Practice Address - Fax:770-306-1343
Is Sole Proprietor?:No
Enumeration Date:2009-02-06
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA308663363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical