Provider Demographics
NPI:1962565887
Name:DYER, MEREDITH MACMILLAN (PA)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:MACMILLAN
Last Name:DYER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11700 MERCY BLVD
Mailing Address - Street 2:BLDG 6
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-1753
Mailing Address - Country:US
Mailing Address - Phone:912-961-8647
Mailing Address - Fax:
Practice Address - Street 1:11700 MERCY BLVD
Practice Address - Street 2:BLDG 6
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-1753
Practice Address - Country:US
Practice Address - Phone:912-961-8647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4945363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA681257393AMedicaid
GAQ74466Medicare UPIN
GA97WCJGLMedicare PIN