Provider Demographics
NPI:1093345134
Name:JUSTICE, MEGAN RANDOLPH (RSA)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:RANDOLPH
Last Name:JUSTICE
Suffix:
Gender:F
Credentials:RSA
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:MEGAN
Other - Last Name:JUSTICE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RSA
Mailing Address - Street 1:162 ABSHIRE LN NE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37323-4426
Mailing Address - Country:US
Mailing Address - Phone:423-544-6993
Mailing Address - Fax:
Practice Address - Street 1:2305 CHAMBLISS AVE NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-3847
Practice Address - Country:US
Practice Address - Phone:423-559-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-16
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN111246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant