Provider Demographics
NPI:1003531146
Name:SMITH, MEGAN (RA)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:RA
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:600 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45331-1944
Mailing Address - Country:US
Mailing Address - Phone:937-417-8378
Mailing Address - Fax:
Practice Address - Street 1:6940 OXFORD GETTYSBURG RD
Practice Address - Street 2:
Practice Address - City:NEW PARIS
Practice Address - State:OH
Practice Address - Zip Code:45347-9030
Practice Address - Country:US
Practice Address - Phone:937-437-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-11
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1632692083P0901X, 405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes405300000XOther Service ProvidersPrevention Professional
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine