Provider Demographics
NPI:1033737754
Name:SHORT, MEAGAN ASHLEY (NP-C)
Entity Type:Individual
Prefix:
First Name:MEAGAN
Middle Name:ASHLEY
Last Name:SHORT
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:MEAGAN
Other - Middle Name:ASHLEY
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:670 DEKALB AVE SE UNIT 4306
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-1927
Mailing Address - Country:US
Mailing Address - Phone:912-596-7985
Mailing Address - Fax:
Practice Address - Street 1:993 JOHNSON FY RD NE STE F210
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1688
Practice Address - Country:US
Practice Address - Phone:404-256-1727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-09
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA268355363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner